Form990


Department of the TreasuryInternal Revenue Service
Return of Organization Exempt From Income Tax
Under section 501(c), 527, or 4947(a)(1) of the Internal Revenue Code (except private foundations)
Do not enter social security numbers on this form as it may be made public.
Go to www.irs.gov/Form990 for instructions and the latest information.
OMB No. 1545-0047
2023
Open to Public Inspection
A For the 2023 calendar year, or tax year beginning 07-01-2023 , and ending 06-30-2024
BCheck if applicable:
CName of organization
Avera Health
 
 
Doing business as
 
 
Number and street (or P.O. box if mail is not delivered to street address)
3900 West Avera Drive 300
 
Room/suite
City or town, state or province, country, and ZIP or foreign postal code
Sioux Falls, SD57108
D Employer identification number

46-0422673
E Telephone number

G Gross receipts $ 278,886,077
F Name and address of principal officer:
James Dover FACHE
3900 West Avera Drive 300
Sioux Falls,SD57108
I
Tax-exempt status: (   ) (insert no.) or
J
Website:
www.avera.org
H(a)
Is this a group return for
subordinates?
H(b)
Are all subordinates
included?
If "No," attach a list. See instructions.
H(c)
Group exemption number 0928
K Form of organization:  
L Year of formation: 1998
M State of legal domicile: SD
Part I
Summary
Activities & Governance 1 Briefly describe the organization’s mission or most significant activities: Promotion of health
2 Check this box
3 Number of voting members of the governing body (Part VI, line 1a) ........ 3 15
4 Number of independent voting members of the governing body (Part VI, line 1b) ..... 4 11
5 Total number of individuals employed in calendar year 2023 (Part V, line 2a) ...... 5 2,069
6 Total number of volunteers (estimate if necessary) ............. 6 11
7a Total unrelated business revenue from Part VIII, column (C), line 12 ........ 7a 7,718,321
b Net unrelated business taxable income from Form 990-T, Part I, line 11 ......... 7b 5,239,067
Revenues Prior Year Current Year
8 Contributions and grants (Part VIII, line 1h) ......... 22,270,065 13,740,538
9 Program service revenue (Part VIII, line 2g) ......... 250,557,105 249,827,079
10 Investment income (Part VIII, column (A), lines 3, 4, and 7d ) .... 12,851,478 13,888,133
11 Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e) -340,137 968,330
12 Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12) 285,338,511 278,424,080
Expenses; 13 Grants and similar amounts paid (Part IX, column (A), lines 1–3 )... 26,892,445 16,682,844
14 Benefits paid to or for members (Part IX, column (A), line 4)..... 0 0
15 Salaries, other compensation, employee benefits (Part IX, column (A), lines 5–10) 171,315,196 159,054,954
16a Professional fundraising fees (Part IX, column (A), line 11e) ..... 0 0
b Total fundraising expenses (Part IX, column (D), line 25) 2,343,131    
17 Other expenses (Part IX, column (A), lines 11a–11d, 11f–24e).... 93,674,720 104,648,744
18 Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25) 291,882,361 280,386,542
19 Revenue less expenses. Subtract line 18 from line 12....... -6,543,850 -1,962,462
Net Assets or Fund Balances; Beginning of Current Year End of Year
20 Total assets (Part X, line 16)............. 1,738,162,649 2,306,128,147
21 Total liabilities (Part X, line 26)............. 1,435,789,048 1,968,523,287
22 Net assets or fund balances. Subtract line 21 from line 20..... 302,373,601 337,604,860
Part II
Signature Block
Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct, and complete. Declaration of preparer (other than officer) is based on all information of which preparer has any knowledge.
Sign Here
Signature of officer Date
Type or print name and title
Paid Preparer Use Only
Print/Type preparer's name
Preparer's signature
Date
PTIN
Firm's name

Firm's EIN
Firm's address



Phone no.
May the IRS discuss this return with the preparer shown above? See Instructions. ..........
For Paperwork Reduction Act Notice, see the separate instructions.
Cat. No. 11282Y Form 990 (2023)
Form 990 (2023)
Page 2
Part III
Statement of Program Service Accomplishments
Check if Schedule O contains a response or note to any line in this Part III..............
1
Briefly describe the organization’s 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.
2
Did the organization undertake any significant program services during the year which were not listed on
the prior Form 990 or 990-EZ? .....................
If "Yes," describe these new services on Schedule O.
3
Did the organization cease conducting, or make significant changes in how it conducts, any program
services? ...........................
If "Yes," describe these changes on Schedule O.
4
Describe the organization’s program service accomplishments for each of its three largest program services, as measured by expenses. Section 501(c)(3) and 501(c)(4) organizations are required to report the amount of grants and allocations to others, the total expenses, and revenue, if any, for each program service reported.
4a (Code:   ) (Expenses $ 238,134,264 including grants of $ 16,682,844 ) (Revenue $ 249,827,079 )
Avera Health is a nonprofit corporation jointly sponsored by the Sisters of the Presentation of the Blessed Virgin Mary of Aberdeen, South Dakota and the Benedictine Convent of the Sacred Heart of Yankton, South Dakota, together referenced as the "Sisters." 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.
4b (Code:   ) (Expenses $   including grants of $   ) (Revenue $   )
4c (Code:   ) (Expenses $   including grants of $   ) (Revenue $   )
4d Other program services (Describe in Schedule O.)
(Expenses $   including grants of $   ) (Revenue $   )
4e Total program service expenses238,134,264
Form 990 (2023)
Form 990 (2023)
Page 3
Part IV
Checklist of Required Schedules
Yes
No
1
Is the organization described in section 501(c)(3) or 4947(a)(1) (other than a private foundation)? If "Yes," complete Schedule AClick to see attachment
List of Attached Documents:
// Content
.....................
1
Yes
 
2
Is the organization required to complete Schedule B, Schedule of Contributors? See instructions. Click to see attachment
List of Attached Documents:
// Content
...
2
Yes
 
3
Did the organization engage in direct or indirect political campaign activities on behalf of or in opposition to candidates for public office? If "Yes," complete Schedule C, Part IClick to see attachment
List of Attached Documents:
// Content
.............
3
 
No
4
Section 501(c)(3) organizations. Did the organization engage in lobbying activities, or have a section 501(h) election in effect during the tax year? If "Yes," complete Schedule C, Part IIClick to see attachment
List of Attached Documents:
// Content
.........
4
Yes
 
5
Is the organization a section 501(c)(4), 501(c)(5), or 501(c)(6) organization that receives membership dues, assessments, or similar amounts as defined in Rev. Proc. 98-19? If "Yes," complete Schedule C, Part IIIClick to see attachment
List of Attached Documents:
// Content
..
5
 
No
6
Did the organization maintain any donor advised funds or any similar funds or accounts for which donors have the right to provide advice on the distribution or investment of amounts in such funds or accounts? If "Yes," complete Schedule D, Part IClick to see attachment
List of Attached Documents:
// Content
.........................
6
 
No
7
Did the organization receive or hold a conservation easement, including easements to preserve open space,
the environment, historic land areas, or historic structures? If "Yes," complete Schedule D, Part IIClick to see attachment
List of Attached Documents:
// Content
....
7
 
No
8
Did the organization maintain collections of works of art, historical treasures, or other similar assets? If "Yes,"
complete Schedule D, Part IIIClick to see attachment
List of Attached Documents:
// Content
..............
8
 
No
9
Did the organization report an amount in Part X, line 21 for escrow or custodial account liability; serve as a custodian for amounts not listed in Part X; or provide credit counseling, debt management, credit repair, or debt negotiation services? If "Yes," complete Schedule D, Part IVClick to see attachment
List of Attached Documents:
// Content
..............
9
Yes
 
10
Did the organization, directly or through a related organization, hold assets in temporarily restricted endowments, permanent endowments, or quasi endowments? If "Yes," complete Schedule D, Part V......
10
Yes
 
11
If the organization’s answer to any of the following questions is "Yes," then complete Schedule D, Parts VI, VII, VIII, IX, or X, as applicable.
a
Did the organization report an amount for land, buildings, and equipment in Part X, line 10? If "Yes," complete
Schedule D, Part VI. Click to see attachment
List of Attached Documents:
// Content
...................
11a
Yes
 
b
Did the organization report an amount for investments—other securities in Part X, line 12 that is 5% or more of its total assets reported in Part X, line 16? If "Yes," complete Schedule D, Part VIIClick to see attachment
List of Attached Documents:
// Content
.......
11b
Yes
 
c
Did the organization report an amount for investments—program related in Part X, line 13 that is 5% or more of its total assets reported in Part X, line 16? If "Yes," complete Schedule D, Part VIIIClick to see attachment
List of Attached Documents:
// Content
.......
11c
 
No
d
Did the organization report an amount for other assets in Part X, line 15 that is 5% or more of its total assets reported in Part X, line 16? If "Yes," complete Schedule D, Part IXClick to see attachment
List of Attached Documents:
// Content
............
11d
Yes
 
e
Did the organization report an amount for other liabilities in Part X, line 25? If "Yes," complete Schedule D, Part XClick to see attachment
List of Attached Documents:
// Content
11e
Yes
 
f
Did the organization’s separate or consolidated financial statements for the tax year include a footnote that addresses the organization’s liability for uncertain tax positions under FIN 48 (ASC 740)? If "Yes," complete Schedule D, Part XClick to see attachment
List of Attached Documents:
// Content
11f
Yes
 
12a
Did the organization obtain separate, independent audited financial statements for the tax year? If "Yes," complete
Schedule D, Parts XI and XIIClick to see attachment
List of Attached Documents:
// Content
......................
12a
 
No
b
Was the organization included in consolidated, independent audited financial statements for the tax year? If "Yes," and if the organization answered "No" to line 12a, then completing Schedule D, Parts XI and XII is optional Click to see attachment
List of Attached Documents:
// Content
12b
Yes
 
13
Is the organization a school described in section 170(b)(1)(A)(ii)? If "Yes," complete Schedule E
13
 
No
14a
Did the organization maintain an office, employees, or agents outside of the United States? .....
14a
 
No
b
Did the organization have aggregate revenues or expenses of more than $10,000 from grantmaking, fundraising, business, investment, and program service activities outside the United States, or aggregate foreign investments valued at $100,000 or more? If "Yes," complete Schedule F, Parts I and IV.........Click to see attachment
List of Attached Documents:
// Content
14b
Yes
 
15
Did the organization report on Part IX, column (A), line 3, more than $5,000 of grants or other assistance to or for any foreign organization? If “Yes,” complete Schedule F, Parts II and IV.....Click to see attachment
List of Attached Documents:
// Content
15
 
No
16
Did the organization report on Part IX, column (A), line 3, more than $5,000 of aggregate grants or other assistance to or for foreign individuals? If “Yes,” complete Schedule F, Parts III and IV...Click to see attachment
List of Attached Documents:
// Content
16
 
No
17
Did the organization report a total of more than $15,000 of expenses for professional fundraising services on Part IX, column (A), lines 6 and 11e? If "Yes," complete Schedule G, Part I. See instructions. ....Click to see attachment
List of Attached Documents:
// Content
17
 
No
18
Did the organization report more than $15,000 total of fundraising event gross income and contributions on Part VIII, lines 1c and 8a? If "Yes," complete Schedule G, Part II............ Click to see attachment
List of Attached Documents:
// Content
18
Yes
 
19
Did the organization report more than $15,000 of gross income from gaming activities on Part VIII, line 9a? If "Yes," complete Schedule G, Part III...................Click to see attachment
List of Attached Documents:
// Content
19
 
No
20a
Did the organization operate one or more hospital facilities? If "Yes," complete Schedule H....
20a
 
No
b
If "Yes" to line 20a, did the organization attach a copy of its audited financial statements to this return?
20b
 
 
21
Did the organization report more than $5,000 of grants or other assistance to any domestic organization or domestic government on Part IX, column (A), line 1? If “Yes,” complete Schedule I, Parts I and II.....Click to see attachment
List of Attached Documents:
// Content
21
Yes
 
Form 990 (2023)
Form 990 (2023)
Page 4
Part IV
Checklist of Required Schedules (continued)
Yes
No
22
Did the organization report more than $5,000 of grants or other assistance to or for domestic individuals on Part IX, column (A), line 2? If “Yes,” complete Schedule I, Parts I and III........Click to see attachment
List of Attached Documents:
// Content
22
Yes
 
23
Did the organization answer "Yes" to Part VII, Section A, line 3, 4, or 5, about compensation of the organization’s current and former officers, directors, trustees, key employees, and highest compensated employees? If "Yes," complete Schedule J....................... Click to see attachment
List of Attached Documents:
// Content
23
Yes
 
24a
Did the organization have a tax-exempt bond issue with an outstanding principal amount of more than $100,000 as of the last day of the year, that was issued after December 31, 2002? If “Yes,” answer lines 24b through 24d and complete Schedule K. If “No,” go to line 25a...............Click to see attachment
List of Attached Documents:
// Content
24a
Yes
 
b
Did the organization invest any proceeds of tax-exempt bonds beyond a temporary period exception?...
24b
 
No
c
Did the organization maintain an escrow account other than a refunding escrow at any time during the year
to defease any tax-exempt bonds? ...............
24c
 
No
d
Did the organization act as an "on behalf of" issuer for bonds outstanding at any time during the year?...
24d
 
No
25a
Section 501(c)(3), 501(c)(4), and 501(c)(29) organizations. Did the organization engage in an excess benefit transaction with a disqualified person during the year? If "Yes," complete Schedule L, Part I .... Click to see attachment
List of Attached Documents:
// Content
25a
 
No
b
Is the organization aware that it engaged in an excess benefit transaction with a disqualified person in a prior year, and that the transaction has not been reported on any of the organization’s prior Forms 990 or 990-EZ? If "Yes," complete Schedule L, Part I.......................Click to see attachment
List of Attached Documents:
// Content
25b
 
No
26
Did the organization report any amount on Part X, line 5 or 22 for receivables from or payables to any current or former officer, director, trustee, key employee, creator or founder, substantial contributor, or 35% controlled entity or family member of any of these persons? If "Yes," complete Schedule L, Part IIClick to see attachment
List of Attached Documents:
// Content
...........
26
Yes
 
27
Did the organization provide a grant or other assistance to any current or former officer, director, trustee, key employee, creator or founder, substantial contributor, or employee thereof, a grant selection committee member, or to a 35% controlled entity (including an employee thereof) or family member of any of these persons?
If "Yes," complete
Schedule L, Part IIIClick to see attachment
List of Attached Documents:
// Content
.........................
27
 
No
28
Was the organization a party to a business transaction with one of the following parties (see the Schedule L, Part IV instructions for applicable filing thresholds, conditions, and exceptions):
a
A current or former officer, director, trustee, key employee, creator or founder, or substantial contributor? If "Yes," complete Schedule L, Part IV......................Click to see attachment
List of Attached Documents:
// Content
28a
 
No
b
A family member of any individual described in line 28a? If "Yes," complete Schedule L, Part IV.....Click to see attachment
List of Attached Documents:
// Content
28b
Yes
 
c
A 35% controlled entity of one or more individuals and/or organizations described in line 28a or 28b? If "Yes," complete Schedule L, Part IV.....................
28c
Yes
 
29
Did the organization receive more than $25,000 in non-cash contributions? If "Yes," complete Schedule M..Click to see attachment
List of Attached Documents:
// Content
29
Yes
 
30
Did the organization receive contributions of art, historical treasures, or other similar assets, or qualified conservation contributions? If "Yes," complete Schedule M .................Click to see attachment
List of Attached Documents:
// Content
30
 
No
31
Did the organization liquidate, terminate, or dissolve and cease operations? If "Yes," complete Schedule N, Part I
31
 
No
32
Did the organization sell, exchange, dispose of, or transfer more than 25% of its net assets? If "Yes," complete Schedule N, Part II........................
32
 
No
33
Did the organization own 100% of an entity disregarded as separate from the organization under Regulations sections 301.7701-2 and 301.7701-3? If "Yes," complete Schedule R, Part I............Click to see attachment
List of Attached Documents:
// Content
33
 
No
34
Was the organization related to any tax-exempt or taxable entity? If "Yes," complete Schedule R, Part II, III, or IV, and Part V, line 1.........................Click to see attachment
List of Attached Documents:
// Content
34
Yes
 
35a
Did the organization have a controlled entity within the meaning of section 512(b)(13)?
35a
Yes
 
b
If ‘Yes’ to line 35a, did the organization receive any payment from or engage in any transaction with a controlled entity within the meaning of section 512(b)(13)? If "Yes," complete Schedule R, Part V, line 2 ...Click to see attachment
List of Attached Documents:
// Content
35b
Yes
 
36
Section 501(c)(3) organizations. Did the organization make any transfers to an exempt non-charitable related organization? If "Yes," complete Schedule R, Part V, line 2............. Click to see attachment
List of Attached Documents:
// Content
36
 
No
37
Did the organization conduct more than 5% of its activities through an entity that is not a related organization and that is treated as a partnership for federal income tax purposes? If "Yes," complete Schedule R, Part VIClick to see attachment
List of Attached Documents:
// Content
37
 
No
38
Did the organization complete Schedule O and provide explanations on Schedule O for Part VI, lines 11b and 19? Note. All Form 990 filers are required to complete Schedule O. ............
38
Yes
 
Part V
Statements Regarding Other IRS Filings and Tax Compliance
Check if Schedule O contains a response or note to any line in this Part V...........
Yes
No
1a
Enter the number reported in box 3 of Form 1096. Enter -0- if not applicable ..
1a
160
b
Enter the number of Forms W-2G included on line 1a. Enter -0- if not applicable .
1b
0
c
Did the organization comply with backup withholding rules for reportable payments to vendors and reportable gaming (gambling) winnings to prize winners? ..................
1c
Yes
 
Form 990 (2023)
Form 990 (2023)
Page 5
Part V
Statements Regarding Other IRS Filings and Tax Compliance (continued)
2a
Enter the number of employees reported on Form W-3, Transmittal of Wage and
Tax Statements, filed for the calendar year ending with or within the year covered by this return ..................
2a
2,069
b
If at least one is reported on line 2a, did the organization file all required federal employment tax returns?
2b
Yes
 
3a
Did the organization have unrelated business gross income of $1,000 or more during the year?...
3a
Yes
 
b
If “Yes,” has it filed a Form 990-T for this year? If “No” to line 3b, provide an explanation in Schedule O...
3b
Yes
 
4a
At any time during the calendar year, did the organization have an interest in, or a signature or other authority over, a financial account in a foreign country (such as a bank account, securities account, or other financial account)? ..
4a
 
No
b
If "Yes," enter the name of the foreign country:
See instructions for filing requirements for FinCEN Form 114, Report of Foreign Bank and Financial Accounts (FBAR).
5a
Was the organization a party to a prohibited tax shelter transaction at any time during the tax year? ..
5a
 
No
b
Did any taxable party notify the organization that it was or is a party to a prohibited tax shelter transaction?
5b
 
No
c
If "Yes," to line 5a or 5b, did the organization file Form 8886-T? ............
5c
 
 
6a
Does the organization have annual gross receipts that are normally greater than $100,000, and did the organization solicit any contributions that were not tax deductible as charitable contributions? ...
6a
 
No
b
If "Yes," did the organization include with every solicitation an express statement that such contributions or gifts were not tax deductible? ......................
6b
 
 
7
Organizations that may receive deductible contributions under section 170(c).
a
Did the organization receive a payment in excess of $75 made partly as a contribution and partly for goods and services provided to the payor? ....................
7a
Yes
 
b
If "Yes," did the organization notify the donor of the value of the goods or services provided? .....
7b
Yes
 
c
Did the organization sell, exchange, or otherwise dispose of tangible personal property for which it was required to file Form 8282? .........................
7c
 
No
d
If "Yes," indicate the number of Forms 8282 filed during the year ....
7d
 
e
Did the organization receive any funds, directly or indirectly, to pay premiums on a personal benefit contract?
7e
 
No
f
Did the organization, during the year, pay premiums, directly or indirectly, on a personal benefit contract? ..
7f
 
No
g
If the organization received a contribution of qualified intellectual property, did the organization file Form 8899 as required? ......................
7g
 
 
h
If the organization received a contribution of cars, boats, airplanes, or other vehicles, did the organization file a Form 1098-C? ..........................
7h
 
 
8
Sponsoring organizations maintaining donor advised funds. Did a donor advised fund maintained by the sponsoring organization have excess business holdings at any time during the year? ........
8
 
 
9
Sponsoring organizations maintaining donor advised funds.
a
Did the sponsoring organization make any taxable distributions under section 4966?........
9a
 
 
b
Did the sponsoring organization make a distribution to a donor, donor advisor, or related person?...
9b
 
 
10
Section 501(c)(7) organizations. Enter:
a
Initiation fees and capital contributions included on Part VIII, line 12 ...
10a
 
b
Gross receipts, included on Form 990, Part VIII, line 12, for public use of club facilities
10b
 
11
Section 501(c)(12) organizations. Enter:
a
Gross income from members or shareholders .........
11a
 
b
Gross income from other sources. (Do not net amounts due or paid to other sources against amounts due or received from them.) ..........
11b
 
12a
Section 4947(a)(1) non-exempt charitable trusts. Is the organization filing Form 990 in lieu of Form 1041?
12a
 
 
b
If "Yes," enter the amount of tax-exempt interest received or accrued during the year.
12b
 
13
Section 501(c)(29) qualified nonprofit health insurance issuers.
a
Is the organization licensed to issue qualified health plans in more than one state? .........
Note. See the instructions for additional information the organization must report on Schedule O.
13a
 
 
b
Enter the amount of reserves the organization is required to maintain by the states in which the organization is licensed to issue qualified health plans ....
13b
 
c
Enter the amount of reserves on hand ............
13c
 
14a
Did the organization receive any payments for indoor tanning services during the tax year?.....
14a
 
No
b
If "Yes," has it filed a Form 720 to report these payments? If "No," provide an explanation in Schedule O..
14b
 
 
15
Is the organization subject to the section 4960 tax on payment(s) of more than $1,000,000 in remuneration or excess parachute payment(s) during the year? ....................
If "Yes," see the instructions and file Form 4720, Schedule N.
15
Yes
 
16
Is the organization an educational institution subject to the section 4968 excise tax on net investment income? ..
If "Yes," complete Form 4720, Schedule O.
16
 
No
17
Section 501(c)(21) organizations. Did the trust, or any disqualified or other person engage in any activities that would result in the imposition of an excise tax under section 4951, 4952, or 4953? ..
If "Yes," complete Form 6069.
17
 
 
Form 990 (2023)
Form 990 (2023)
Page 6
Part VI
Governance, Management, and Disclosure. For each "Yes" response to lines 2 through 7b below, and for a "No" response to lines 8a, 8b, or 10b below, describe the circumstances, processes, or changes in Schedule O. See instructions.
Check if Schedule O contains a response or note to any line in this Part VI..............
Section A. Governing Body and Management
Yes
No
1a
Enter the number of voting members of the governing body at the end of the tax year
1a
15
If there are material differences in voting rights among members of the governing body, or if the governing body delegated broad authority to an executive committee or similar committee, explain in Schedule O.
b
Enter the number of voting members included in line 1a, above, who are independent
1b
11
2
Did any officer, director, trustee, or key employee have a family relationship or a business relationship with any other officer, director, trustee, or key employee? .................
2
Yes
 
3
Did the organization delegate control over management duties customarily performed by or under the direct supervision of officers, directors or trustees, or key employees to a management company or other person? .
3
 
No
4
Did the organization make any significant changes to its governing documents since the prior Form 990 was filed? .
4
 
No
5
Did the organization become aware during the year of a significant diversion of the organization’s assets? .
5
 
No
6
Did the organization have members or stockholders? ................
6
Yes
 
7a
Did the organization have members, stockholders, or other persons who had the power to elect or appoint one or more members of the governing body? ....................
7a
Yes
 
b
Are any governance decisions of the organization reserved to (or subject to approval by) members, stockholders, or persons other than the governing body? ...................
7b
Yes
 
8
Did the organization contemporaneously document the meetings held or written actions undertaken during the year by the following:
a
The governing body? .......................
8a
Yes
 
b
Each committee with authority to act on behalf of the governing body? ............
8b
 
No
9
Is there any officer, director, trustee, or key employee listed in Part VII, Section A, who cannot be reached at the organization’s mailing address? If "Yes," provide the names and addresses in Schedule O.......
9
 
No
Section B. Policies (This Section B requests information about policies not required by the Internal Revenue Code.)
Yes
No
10a
Did the organization have local chapters, branches, or affiliates? ............
10a
 
No
b
If "Yes," did the organization have written policies and procedures governing the activities of such chapters, affiliates, and branches to ensure their operations are consistent with the organization's exempt purposes?
10b
 
 
11a
Has the organization provided a complete copy of this Form 990 to all members of its governing body before filing the form? ............................
11a
 
No
b
Describe on Schedule O the process, if any, used by the organization to review this Form 990. .....
12a
Did the organization have a written conflict of interest policy? If "No," go to line 13.......
12a
Yes
 
b
Were officers, directors, or trustees, and key employees required to disclose annually interests that could give rise to conflicts? ..........................
12b
Yes
 
c
Did the organization regularly and consistently monitor and enforce compliance with the policy? If "Yes," describe on Schedule O how this was done...................
12c
Yes
 
13
Did the organization have a written whistleblower policy? ...............
13
Yes
 
14
Did the organization have a written document retention and destruction policy? .........
14
Yes
 
15
Did the process for determining compensation of the following persons include a review and approval by independent persons, comparability data, and contemporaneous substantiation of the deliberation and decision?
a
The organization’s CEO, Executive Director, or top management official ...........
15a
Yes
 
b
Other officers or key employees of the organization ................
15b
Yes
 
If "Yes" to line 15a or 15b, describe the process on Schedule O. See instructions.
16a
Did the organization invest in, contribute assets to, or participate in a joint venture or similar arrangement with a taxable entity during the year? ......................
16a
Yes
 
b
If "Yes," did the organization follow a written policy or procedure requiring the organization to evaluate its participation in joint venture arrangements under applicable federal tax law, and take steps to safeguard the organization’s exempt status with respect to such arrangements? ............
16b
 
No
Section C. Disclosure
17
List the states with which a copy of this Form 990 is required to be filed
AK , AL , AR , CA , CO , CT , DC , FL , GA , HI , IL , KS , ME , MD , MA , MI , MN , MS , MO , NV , NH , NJ , NM , NY , NC , ND , OH , OK , OR , PA , RI , SC , TN , VA , WA , WV , WI
18
Section 6104 requires an organization to make its Form 1023 (1024 or 1024-A, if applicable), 990, and 990-T (section 501(c)(3)s only) available for public inspection. Indicate how you made these available. Check all that apply.
19
Describe in Schedule O whether (and if so, how) the organization made its governing documents, conflict of interest policy, and financial statements available to the public during the tax year.
20
State the name, address, and telephone number of the person who possesses the organization's books and records:
Jamie Schaefer3900 W Avera Dr Ste 300   Sioux Falls,SD57108 (605) 322-3992
Form 990 (2023)
Form 990 (2023)
Page 7
Part VII
Compensation of Officers, Directors,Trustees, Key Employees, Highest Compensated Employees, and Independent Contractors
Check if Schedule O contains a response or note to any line in this Part VII..............
Section A. Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees
1a Complete this table for all persons required to be listed. Report compensation for the calendar year ending with or within the organization’s tax year.
RoundBullet List all of the organization’s current officers, directors, trustees (whether individuals or organizations), regardless of amount
of compensation. Enter -0- in columns (D), (E), and (F) if no compensation was paid.

RoundBullet List all of the organization’s current key employees, if any. See the instructions for definition of "key employee."
RoundBullet List the organization’s five current highest compensated employees (other than an officer, director, trustee or key employee)
who received reportable compensation (box 5 of Form W-2, box 6 of Form 1099-MISC, and/or box 1 of Form 1099-NEC) of more than $100,000 from the organization and any related organizations.

RoundBullet List all of the organization’s former officers, key employees, or highest compensated employees who received more than $100,000
of reportable compensation from the organization and any related organizations.

RoundBullet List all of the organization’s former directors or trustees that received, in the capacity as a former director or trustee of the
organization, more than $10,000 of reportable compensation from the organization and any related organizations.

See the instructions for the order in which to list the persons above.
Check this box if neither the organization nor any related organization compensated any current officer, director, or trustee.
(A)
Name and title 		(B)
Average hours per week (list any hours for related organizations below dotted line) 		(C)
Position (do not check more than one box, unless person is both an officer and a director/trustee) 		(D)
Reportable compensation from the organization (W-2/1099-MISC/1099-NEC) 		(E)
Reportable compensation from related organizations (W-2/1099-MISC/1099-NEC) 		(F)
Estimated amount of other compensation from the organization and related organizations
Individual Trustee or Director; Institutional Trustee; OfficerInd; Key Employee; Highest compensated employee; FormerOfcrDirectorTrusteeInd;
(1) James Dover......................................................................
President/CEO (Eff 10/2023)
 45.00
.................
1.00 		X   X       396,393 0 3,389
(2) Bob Sutton......................................................................
President/CEO (End 08/2023)
 45.00
.................
1.00 		X   X       2,080,463 0 60,433
(3) Dr Luis Rojas-Espaillat......................................................................
Chair, Gynecologic Oncology
 5.00
.................
40.00 		X   X       0 697,255 53,521
(4) Lori Essig......................................................................
Vice Chair
 5.00
.................
0.00 		X   X       0 0 0
(5) Sister Candyce Chrystal......................................................................
Board Member
 5.00
.................
3.00 		X           0 0 0
(6) Sister Pam Donelan......................................................................
Board Member
 5.00
.................
2.00 		X           0 0 0
(7) Robert Fouberg......................................................................
Board Member
 5.00
.................
0.00 		X           0 0 0
(8) Doneen Hollingsworth......................................................................
Board Member
 5.00
.................
0.00 		X           0 0 0
(9) Sister Mary Jaeger......................................................................
Board Member
 5.00
.................
0.00 		X           0 0 0
(10) Dr Wayne Kindle......................................................................
Board Member
 5.00
.................
0.00 		X           0 0 0
(11) Sister Debra Kolecka......................................................................
Board Member
 5.00
.................
4.00 		X           0 0 0
(12) Sister Mary Kay Panowicz......................................................................
Board Member
 5.00
.................
1.00 		X           0 0 0
(13) Sister Roxanne Seifert......................................................................
Board Member
 5.00
.................
2.00 		X           0 0 0
(14) Clark Sinclair......................................................................
Board Member
 5.00
.................
0.00 		X           0 0 0
(15) Dr Katherine Wang......................................................................
Board Member, Neonatology
 5.00
.................
40.00 		X           0 507,178 17,435
(16) Dr Jason Wickersham......................................................................
Board Member, Family Medicine/OBGYN
 5.00
.................
40.00 		X           0 463,101 50,160
(17) Julie Lautt......................................................................
CFO, Treasurer
 45.00
.................
1.40 		    X       1,203,675 0 19,401
Form 990 (2023)
Form 990 (2023)
Page 8
Part VII
Section A. Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees (continued)
(A)
Name and title 		(B)
Average hours per week (list any hours for related organizations below dotted line) 		(C)
Position (do not check more than one box, unless person is both an officer and a director/trustee) 		(D)
Reportable compensation from the organization (W-2/1099-MISC/1099-NEC) 		(E)
Reportable compensation from related organizations (W-2/1099-MISC/1099-NEC) 		(F)
Estimated amount of other compensation from the organization and related organizations
Individual Trustee or Director; Institutional Trustee; OfficerInd; Key Employee; Highest compensated employee; FormerOfcrDirectorTrusteeInd;
(18) Richard Korman........................................................................
Chief Legal Officer, Secretary
 40.00
.......................0.00 		    X       808,575 0 50,377
(19) Daniel Bjerknes........................................................................
President/CEO, St. Luke's
 0.00
.......................40.00 		      X     503,084 0 50,471
(20) Doug Ekeren........................................................................
President/CEO, Sacred Heart
 0.00
.......................41.00 		      X     652,618 0 50,377
(21) David Flicek........................................................................
Chief Operating Officer
 40.00
.......................0.00 		      X     1,371,591 0 45,097
(22) Shantel Krebs........................................................................
President/CEO, St. Mary's
 0.00
.......................42.00 		      X     83,231 186,423 18,256
(23) Dr Ronald Place........................................................................
President/CEO, McKennan
 0.00
.......................40.00 		      X     726,858 0 17,030
(24) Dr Hillary Rockwell........................................................................
President/CEO, Queen of Peace
 0.00
.......................40.00 		      X     245,314 221,675 57,403
(25) Debbie Streier........................................................................
President/CEO, Marshall
 0.00
.......................44.50 		      X     489,400 0 17,435
(26) Shandon Hatch........................................................................
Radiology
 0.00
.......................40.00 		        X   656,579 0 57,402
(27) Bruk Kammerman........................................................................
Sr. VP - Chief Information
 40.00
.......................0.00 		        X   696,536 0 17,939
(28) Kevin Post........................................................................
Chief Medical Officer
 40.00
.......................0.00 		        X   800,524 0 60,452
(29) Casey Swenson........................................................................
Radiology
 0.00
.......................40.00 		        X   733,755 0 57,633
(30) Kimberly Jensen........................................................................
Chief Human Resources Officer
 40.00
.......................0.00 		        X   650,782 0 43,547
(31) Thomas Clark Former........................................................................
Chief Strategy & Growth Officer
 40.00
.......................1.00 		          X 1,666,396 0 25,250
(32) David Erickson........................................................................
Former Chief Medical Officer
 0.00
.......................0.00 		          X 630,520 0 16,500
1b Sub-Total..............
c Total from continuation sheets to Part VII, Section A..
d Total (add lines 1b and 1c)......... 14,396,294 2,075,632 789,508
2
Total number of individuals (including but not limited to those listed above) who received more than $100,000 of reportable compensation from the organization 252
Yes
No
3
Did the organization list any former officer, director or trustee, key employee, or highest compensated employee on line 1a? If "Yes," complete Schedule J for such individual ..............
3
Yes
 
4
For any individual listed on line 1a, is the sum of reportable compensation and other compensation from the organization and related organizations greater than $150,000? If "Yes," complete Schedule J for such
individual...........................
4
Yes
 
5
Did any person listed on line 1a receive or accrue compensation from any unrelated organization or individual for services rendered to the organization? If "Yes," complete Schedule J for such person ........
5
 
No
Section B. Independent Contractors
1
Complete this table for your five highest compensated independent contractors that received more than $100,000 of compensation from the organization. Report compensation for the calendar year ending with or within the organization’s tax year.
(A)
Name and business address 		(B)
Description of services 		(C)
Compensation
CDW LLC

230 N Milwaukee Ave
Vernon Hills,IL60061 		Software; Hardware; Services 17,263,547
Medical Information Technology Inc

7 Blue Hill River Rd
Canton,MA02021 		Software; Services 6,235,476
MedSpeed

140 Industrial Drive
Elmhurst,IL60126 		Courier Services 5,017,560
Microsoft Corporation

1950 N Stemmons Fwy Ste 5010
Dallas,TX75207 		Software; Services 4,939,072
Mediability Inc

4742 42nd Ave SW 323
Seattle,WA98116 		Marketing Services 4,357,381
2
Total number of independent contractors (including but not limited to those listed above) who received more than $100,000 of compensation from the organization 95
Form 990 (2023)
Form 990 (2023)
Page 9
Part VIII
Statement of Revenue
Check if Schedule O contains a response or note to any line in this Part VIII.............
(A)
Total revenue 		(B)
Related or
exempt
function
revenue 		(C)
Unrelated
business
revenue 		(D)
Revenue
excluded from
tax under sections
512 - 514
Contributions, Gifts, Grants, and OtherAmt Similar Amounts 1a Federated campaigns..1a 285,822
b Membership dues..1b  
c Fundraising events..1c 738,655
d Related organizations1d 101,872
e Government grants (contributions)1e 1,952,594
f All other contributions, gifts, grants, and similar amounts not included above1f 10,661,595
g Noncash contributions included in lines 1a - 1f:$ 1g 116,509
h Total. Add lines 1a-1f....... 13,740,538
Program Service RevenueAmt Business Code
2a ACS revenue 900099 213,910,172 213,910,172    
b Other revenue 900099 24,611,663 23,787,970 823,693  
c PACE revenue 561000 7,005,261 88,567 6,916,694  
d Premier expense credits 900099 4,299,983 4,299,983    
e
f All other program service revenue.        
g Total. Add lines 2a–2f ..... 249,827,079
OtherAmtRevenueAmt 3 Investment income (including dividends, interest, and othersimilar amounts) ...... 11,863,007     11,863,007
4 Income from investment of tax-exempt bond proceeds        
5 Royalties...........        
(i) Real (ii) Personal
6a Gross rents 6a 179,197  
b Less: rental expenses 6b 161,338  
c Rental income or (loss) 6c 17,859  
d Net rental income or (loss)....... 17,859     39,925
(i) Securities (ii) Other
7a Gross amount from sales of assets other than inventory 7a 2,116,502  
b Less: cost or other basis and sales expenses 7b 0 91,376
c Gain or (loss) 7c 2,116,502 -91,376
d Net gain or (loss)......... 2,025,126     2,025,126
8a Gross income from fundraising events (not including $ 738,655of contributions reported on line 1c). See Part IV, line 18 ....
8a 1,159,754
b Less: direct expenses ... 8b 209,283
c Net income or (loss) from fundraising events.. 950,471   950,471
9a Gross income from gaming activities.
See Part IV, line 19 ...
9a  
b Less: direct expenses ... 9b  
c Net income or (loss) from gaming activities..        
10a Gross sales of inventory, less
returns and allowances ..
10a  
b Less: cost of goods sold .. 10b  
c Net income or (loss) from sales of inventory..        
OtherRevenueMiscAmt
Business Code
11a            
b            
c            
d All other revenue ....        
e Total. Add lines 11a–11d ......  
12 Total revenue. See instructions..... 278,424,080 242,086,692 7,718,321 14,878,529
Form 990 (2023)
Form 990 (2023)
Page 10
Part IX
Statement of Functional Expenses
Section 501(c)(3) and 501(c)(4) organizations must complete all columns. All other organizations must complete column (A).Check if Schedule O contains a response or note to any line in this Part IX..............
Do not include amounts reported on lines 6b,
7b, 8b, 9b, and 10b of Part VIII. 		(A)
Total expenses 		(B)
Program service expenses 		(C)
Management and general expenses 		(D)
Fundraising
expenses
1 Grants and other assistance to domestic organizations and domestic governments. See Part IV, line 21 .... 16,586,102 16,586,102
2 Grants and other assistance to domestic individuals. See Part IV, line 22 ........... 96,742 96,742
3 Grants and other assistance to foreign organizations, foreign governments, and foreign individuals. See Part IV, lines 15 and 16. .............    
4 Benefits paid to or for members .......    
5 Compensation of current officers, directors, trustees, and key employees ........... 10,093,148   10,093,148  
6 Compensation not included above, to disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B) ......... 278,417 278,417    
7 Other salaries and wages........ 133,747,476 112,727,408 19,652,762 1,367,306
8 Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) .... 5,510,072 5,199,171 249,535 61,366
9 Other employee benefits ....... -333,220 -2,975,958 2,432,345 210,393
10 Payroll taxes ........... 9,759,061 8,888,063 774,051 96,947
11 Fees for services (non-employees):        
a Management ......        
b Legal ......... 398,512 94,034 304,478  
c Accounting ........... 1,544,794 1,503,794 41,000  
d Lobbying ........... 154,266 154,266    
e Professional fundraising services. See Part IV, line 17    
f Investment management fees ......        
g Other (If line 11g amount exceeds 10% of line 25, column (A) amount, list line 11g expenses on Schedule O) 18,191,793 15,744,602 2,311,435 135,756
12 Advertising and promotion .... 7,993,999 7,859,069 24,040 110,890
13 Office expenses ....... 7,443,362 7,338,504 43,244 61,614
14 Information technology ...... 39,259,015 38,418,550 576,291 264,174
15 Royalties ..        
16 Occupancy ........... 4,690,428 1,430,945 3,259,483  
17 Travel ............ 1,010,991 806,178 183,537 21,276
18 Payments of travel or entertainment expenses for any federal, state, or local public officials .        
19 Conferences, conventions, and meetings .... 811,379 720,169 87,107 4,103
20 Interest ........... 634,536 526,585 107,951  
21 Payments to affiliates .......        
22 Depreciation, depletion, and amortization .. 22,247,685 21,056,924 1,187,885 2,876
23 Insurance ... -3,638,478 -2,195,706 -1,442,772  
24 Other expenses. Itemize expenses not covered above (List miscellaneous expenses in line 24e. If line 24e amount exceeds 10% of line 25, column (A) amount, list line 24e expenses on Schedule O.)
a UBI tax 2,758,317 2,758,317    
b Medical supplies 972,556 932,578 37,837 2,141
c Equip Lease/Rental 98,923 88,314 9,996 613
d Bad debt expense 85,385 85,385    
e All other expenses -8,719 11,811 -24,206 3,676
25 Total functional expenses. Add lines 1 through 24e 280,386,542 238,134,264 39,909,147 2,343,131
26 Joint costs. Complete this line only if the organization reported in column (B) joint costs from a combined educational campaign and fundraising solicitation. Check here if following SOP 98-2 (ASC 958-720).        
Form 990 (2023)
Form 990 (2023)
Page 11
Part X
Balance Sheet
Check if Schedule O contains a response or note to any line in this Part IX..............
(A)
Beginning of year 		(B)
End of year
Assets 1 Cash–non-interest-bearing ........   1  
2 Savings and temporary cash investments ......... 39,556,446 2 185,193,801
3 Pledges and grants receivable, net ...... 1,454,625 3 1,414,472
4 Accounts receivable, net ............. 27,678,643 4 28,855,505
5 Loans and other receivables from any current or former officer, director, trustee, key employee, creator or founder, substantial contributor, or 35% controlled entity or family member of any of these persons .......
  5 2,288
6 Loans and other receivables from other disqualified persons (as defined under section 4958(f)(1)), and persons described in section 4958(c)(3)(B) ...
  6  
7 Notes and loans receivable, net ...........   7  
8 Inventories for sale or use ............ 9,452,715 8 7,943,618
9 Prepaid expenses and deferred charges ...... 15,507,258 9 27,068,144
10a Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D 10a 268,420,736
b Less: accumulated depreciation 10b 170,652,334 93,208,062 10c 97,768,402
11 Investments—publicly traded securities . 1,261,490,473 11 1,667,210,051
12 Investments—other securities. See Part IV, line 11 ..... 150,197,416 12 136,750,549
13 Investments—program-related. See Part IV, line 11 .. 18,492 13 41,565
14 Intangible assets ............... 16,197,241 14 16,197,241
15 Other assets. See Part IV, line 11 ........... 123,401,278 15 137,682,511
16 Total assets. Add lines 1 through 15 (must equal line 33)... 1,738,162,649 16 2,306,128,147
Liabilities 17 Accounts payable and accrued expenses ..... 26,358,847 17 36,735,756
18 Grants payable ...   18  
19 Deferred revenue ......... 11,588,034 19 5,077,859
20 Tax-exempt bond liabilities ......... 15,361,822 20 36,331,786
21 Escrow or custodial account liability. Complete Part IV of Schedule D 1,035,287,668 21 1,433,900,514
22 Loans and other payables to any current or former officer, director, trustee, key employee, creator or founder, substantial contributor, or 35% controlled entity or family member of any of these persons .........
  22  
23 Secured mortgages and notes payable to unrelated third parties .. 19,295,412 23 18,589,482
24 Unsecured notes and loans payable to unrelated third parties ..   24  
25 Other liabilities (including federal income tax, payables to related third parties, and other liabilities not included on lines 17 - 24). Complete Part X of Schedule D 327,897,265 25 437,887,890
26 Total liabilities. Add lines 17 through 25.. 1,435,789,048 26 1,968,523,287
Net Assets or Fund Balance Organizations that follow FASB ASC 958, check here and complete lines 27, 28, 32, and 33.
27 Net assets without donor restrictions .......... 286,933,501 27 320,611,813
28 Net assets with donor restrictions ........... 15,440,100 28 16,993,047
Organizations that do not follow FASB ASC 958, check here right arrow and complete lines 29 through 33.
29 Capital stock or trust principal, or current funds .....   29  
30 Paid-in or capital surplus, or land, building or equipment fund ...   30  
31 Retained earnings, endowment, accumulated income, or other funds   31  
32 Total net assets or fund balances ........... 302,373,601 32 337,604,860
33 Total liabilities and net assets/fund balances ........ 1,738,162,649 33 2,306,128,147
Form 990 (2023)
Form 990 (2023)
Page 12
Part XI
Reconcilliation of Net Assets
Check if Schedule O contains a response or note to any line in this Part XI..............
1
Total revenue (must equal Part VIII, column (A), line 12) ............
1
278,424,080
2
Total expenses (must equal Part IX, column (A), line 25) ............
2
280,386,542
3
Revenue less expenses. Subtract line 2 from line 1 ..............
3
-1,962,462
4
Net assets or fund balances at beginning of year (must equal Part X, line 32, column (A)) ..
4
302,373,601
5
Net unrealized gains (losses) on investments ...............
5
32,247,346
6
Donated services and use of facilities .................
6
 
7
Investment expenses .....................
7
 
8
Prior period adjustments .....................
8
 
9
Other changes in net assets or fund balances (explain in Schedule O) ........
9
4,946,375
10
Net assets or fund balances at end of year. Combine lines 3 through 9 (must equal Part X, line 32, column (B))
10
337,604,860
Part XII
Financial Statements and Reporting
Check if Schedule O contains a response or note to any line in this Part XII.............
Yes
No
1
Accounting method used to prepare the Form 990:  
If the organization changed its method of accounting from a prior year or checked "Other," explain on
Schedule O.
2a
Were the organization’s financial statements compiled or reviewed by an independent accountant?
2a
 
No
If ‘Yes,’ check a box below to indicate whether the financial statements for the year were compiled or reviewed on a separate basis, consolidated basis, or both:
b
Were the organization’s financial statements audited by an independent accountant?
2b
Yes
 
If ‘Yes,’ check a box below to indicate whether the financial statements for the year were audited on a separate basis, consolidated basis, or both:
c
If "Yes," to line 2a or 2b, does the organization have a committee that assumes responsibility for oversight of the audit, review, or compilation of its financial statements and selection of an independent accountant?
2c
Yes
 
If the organization changed either its oversight process or selection process during the tax year, explain in Schedule O.
3a
As a result of a federal award, was the organization required to undergo an audit or audits as set forth in the Uniform Guidance, 2 C.F.R. Part 200, Subpart F?
3a
Yes
 
b
If "Yes," did the organization undergo the required audit or audits? If the organization did not undergo the required audit or audits, explain why in Schedule O and describe any steps taken to undergo such audits.
3b
Yes
 
Form 990 (2023)
Form 990 (2023)
Additional Data


Software ID:  
Software Version:  
Form 990, Special Condition Description:
Special Condition Description
SCHEDULE A
(Form 990)

Department of the Treasury
Internal Revenue Service
Public Charity Status and Public Support
Complete if the organization is a section 501(c)(3) organization or a section 4947(a)(1) nonexempt charitable trust.
right arrow Attach to Form 990 or Form 990-EZ.
right arrow Go to www.irs.gov/Form990 for instructions and the latest information.
OMB No. 1545-0047
2023
Open to Public
Inspection
Name of the organization
Avera Health
 
Employer identification number

46-0422673
Part I
Reason for Public Charity Status (All organizations must complete this part.) See instructions.
The organization is not a private foundation because it is: (For lines 1 through 12, check only one box.)
1
A church, convention of churches, or association of churches described in section 170(b)(1)(A)(i).
2
A school described in section 170(b)(1)(A)(ii). (Attach Schedule E (Form 990).)
3
A hospital or a cooperative hospital service organization described in section 170(b)(1)(A)(iii).
4
A medical research organization operated in conjunction with a hospital described in section 170(b)(1)(A)(iii). Enter the hospital's name, city, and state:

5
An organization operated for the benefit of a college or university owned or operated by a governmental unit described in section 170(b)(1)(A)(iv). (Complete Part II.)
6
A federal, state, or local government or governmental unit described in section 170(b)(1)(A)(v).
7
An organization that normally receives a substantial part of its support from a governmental unit or from the general public described in section 170(b)(1)(A)(vi). (Complete Part II.)
8
A community trust described in section 170(b)(1)(A)(vi). (Complete Part II.)
9
An agricultural research organization described in 170(b)(1)(A)(ix) operated in conjunction with a land-grant college or university or a non-land grant college of agriculture. See instructions. Enter the name, city, and state of the college or university:
10
An organization that normally receives: (1) more than 33 1/3% of its support from contributions, membership fees, and gross receipts from activities related to its exempt functions—subject to certain exceptions, and (2) no more than 33 1/3% of its support from gross investment income and unrelated business taxable income (less section 511 tax) from businesses acquired by the organization after June 30, 1975. See section 509(a)(2). (Complete Part III.)
11
12
An organization organized and operated exclusively for the benefit of, to perform the functions of, or to carry out the purposes of one or more publicly supported organizations described in section 509(a)(1) or section 509(a)(2). See section 509(a)(3). Check the box on lines 12a through 12d that describes the type of supporting organization and complete lines 12e, 12f, and 12g.
a
Type I. A supporting organization operated, supervised, or controlled by its supported organization(s), typically by giving the supported organization(s) the power to regularly appoint or elect a majority of the directors or trustees of the supporting organization. You must complete Part IV, Sections A and B.
b
Type II. A supporting organization supervised or controlled in connection with its supported organization(s), by having control or management of the supporting organization vested in the same persons that control or manage the supported organization(s). You must complete Part IV, Sections A and C.
c
Type III functionally integrated. A supporting organization operated in connection with, and functionally integrated with, its supported organization(s) (see instructions). You must complete Part IV, Sections A, D, and E.
d
Type III non-functionally integrated. A supporting organization operated in connection with its supported organization(s) that is not functionally integrated. The organization generally must satisfy a distribution requirement and an attentiveness requirement (see instructions). You must complete Part IV, Sections A and D, and Part V.
e
Check this box if the organization received a written determination from the IRS that it is a Type I, Type II, Type III functionally integrated, or Type III non-functionally integrated supporting organization.
f
Enter the number of supported organizations ...............................  
g
Provide the following information about the supported organization(s).
(i) Name of supported organization (ii) EIN (iii) Type of organization (described on lines 1- 10 above (see instructions)) (iv) Is the organization listed in your governing document? (v) Amount of monetary support (see instructions) (vi) Amount of other support (see instructions)
Yes No
Total
 
   
For Paperwork Reduction Act Notice, see the Instructions for
Form 990 or 990-EZ.
Cat. No. 11285F
Schedule A (Form 990) 2023

Schedule A (Form 990) 2023
Page 2
Part II
Support Schedule for Organizations Described in Sections 170(b)(1)(A)(iv) and 170(b)(1)(A)(vi)
(Complete only if you checked the box on line 5, 7, or 8 of Part I or if the organization failed to qualify under Part III. If the organization failed to qualify under the tests listed below, please complete Part III.)
Section A. Public Support
Calendar year (or fiscal year beginning in) right arrow (a) 2019 (b) 2020 (c) 2021 (d) 2022 (e) 2023 (f) Total
1 Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grant.") ..            
2 Tax revenues levied for the organization's benefit and either paid to or expended on its behalf ....            
3 The value of services or facilities furnished by a governmental unit to the organization without charge..            
4 Total. Add lines 1 through 3            
5 The portion of total contributions by each person (other than a governmental unit or publicly supported organization) included on line 1 that exceeds 2% of the amount shown on line 11, column (f) ..  
6 Public support. Subtract line 5 from line 4.  
Section B. Total Support
Calendar year (or fiscal year beginning in) right arrow (a) 2019 (b) 2020 (c) 2021 (d) 2022 (e) 2023 (f) Total
7 Amounts from line 4..            
8 Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources...            
9 Net income from unrelated business activities, whether or not the business is regularly carried on..            
10 Other income. Do not include gain or loss from the sale of capital assets (Explain in Part VI.)..            
11 Total support. Add lines 7 through 10  
12
12
 
13
First 5 years. If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a section 501(c)(3) organization, check this box and stop here ........................................right arrow
Section C. Computation of Public Support Percentage
14
14
 
15
15
 
16a
33 1/3% support test—2023. If the organization did not check the box on line 13, and line 14 is 33 1/3% or more, check this box
and stop here. The organization qualifies as a publicly supported organization .......................right arrow
b
33 1/3% support test—2022. If the organization did not check a box on line 13 or 16a, and line 15 is 33 1/3% or more, check this
box and stop here. The organization qualifies as a publicly supported organization ..................... right arrow
17a
10%-facts-and-circumstances test—2023. If the organization did not check a box on line 13, 16a, or 16b, and line 14 is 10% or more, and if the organization meets the "facts-and-circumstances" test, check this box and stop here. Explain in Part VI how the organization meets the "facts-and-circumstances" test. The organization qualifies as a publicly supported organization ............ right arrow
b
10%-facts-and-circumstances test—2022. If the organization did not check a box on line 13, 16a, 16b, or 17a, and line 15 is 10% or more, and if the organization meets the "facts-and-circumstances" test, check this box and stop here. Explain in Part VI how the organization meets the "facts-and-circumstances" test. The organization qualifies as a publicly supported organization ............ right arrow
18
Private foundation. If the organization did not check a box on line 13, 16a, 16b, 17a, or 17b, check this box and see
instructions ..................................................... right arrow
Schedule A (Form 990) 2023

Schedule A (Form 990) 2023
Page 3
Part III
Support Schedule for Organizations Described in Section 509(a)(2)
(Complete only if you checked the box on line 10 of Part I or if the organization failed to qualify under Part II. If the organization fails to qualify under the tests listed below, please complete Part II.)
Section A. Public Support
Calendar year (or fiscal year beginning in) right arrow (a) 2019 (b) 2020 (c) 2021 (d) 2022 (e) 2023 (f) Total
1 Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") . 23,574,843 21,836,149 40,871,703 22,270,065 13,740,538 122,293,298
2 Gross receipts from admissions, merchandise sold or services performed, or facilities furnished in any activity that is related to the organization's tax-exempt purpose 266,987,769 278,210,607 277,318,143 249,787,142 252,265,042 1,324,568,703
3 Gross receipts from activities that are not an unrelated trade or business under section 513 .....            
4 Tax revenues levied for the organization's benefit and either paid to or expended on its behalf...            
5 The value of services or facilities furnished by a governmental unit to the organization without charge            
6 Total. Add lines 1 through 5 290,562,612 300,046,756 318,189,846 272,057,207 266,005,580 1,446,862,001
7a Amounts included on lines 1, 2, and 3 received from disqualified persons 368,889 446,030 157,537 58,522 158,013 1,188,991
b Amounts included on lines 2 and 3 received from other than disqualified persons that exceed the greater of $5,000 or 1% of the amount on line 13 for the year. 178,295,346 177,531,681 212,485,978 194,153,214 177,815,503 940,281,722
c Add lines 7a and 7b.. 178,664,235 177,977,711 212,643,515 194,211,736 177,973,516 941,470,713
8 Public support. (Subtract line 7c from line 6.) 505,391,288
Section B. Total Support
Calendar year (or fiscal year beginning in) right arrow (a) 2019 (b) 2020 (c) 2021 (d) 2022 (e) 2023 (f) Total
9 Amounts from line 6... 290,562,612 300,046,756 318,189,846 272,057,207 266,005,580 1,446,862,001
10a Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources.. 22,385 199,301 1,830,463 2,609,325 1,863,854 6,525,328
b Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975. 1,094,391 2,515,692 2,884,876 5,736,624 4,138,863 16,370,446
c Add lines 10a and 10b. 1,116,776 2,714,993 4,715,339 8,345,949 6,002,717 22,895,774
11 Net income from unrelated business activities not included on line 10b, whether or not the business is regularly carried on. 369,995 197,164 243,606 540,124 950,471 2,301,360
12 Other income. Do not include gain or loss from the sale of capital assets (Explain in Part VI.) ..            
13 Total support. (Add lines 9, 10c, 11, and 12.).. 292,049,383 302,958,913 323,148,791 280,943,280 272,958,768 1,472,059,135
14
First 5 years. If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a section 501(c)(3) organization, check this box and stop here................................................. right arrow
Section C. Computation of Public Support Percentage
15
15
34.330 %
16
16
35.480 %
Section D. Computation of Investment Income Percentage
17
17
1.560 %
18
18
1.290 %
19a
33 1/3% support tests-2023. If the organization did not check the box on line 14, and line 15 is more than 33 1/3%, and line 17 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization ....... right arrow
b
33 1/3 % support tests—2022. If the organization did not check a box on line 14 or line 19a, and line 16 is more than 33 1/3% and line 18 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization ..... right arrow
20
Private foundation. If the organization did not check a box on line 14, 19a, or 19b, check this box and see instructions .... right arrow
Schedule A (Form 990) 2023

Schedule A (Form 990) 2023
Page 4
Part IV
Supporting Organizations
(Complete only if you checked a box on line 12 of Part I. If you checked box 12a, of Part I, complete Sections A and B. If you checked box 12b, of Part I, complete Sections A and C. If you checked box 12c, of Part I, complete Sections A, D, and E. If you checked box12d, of Part I, complete Sections A and D, and complete Part V.)
Section A. All Supporting Organizations
Yes
No
1
Are all of the organization’s supported organizations listed by name in the organization’s governing documents?
If "No," describe in Part VI how the supported organizations are designated. If designated by class or purpose,
describe the designation. If historic and continuing relationship, explain.
1
 
 
2
Did the organization have any supported organization that does not have an IRS determination of status under section 509(a)(1) or (2)? If "Yes," explain in Part VI how the organization determined that the supported organization was described in section 509(a)(1) or (2).
2
 
 
3a
Did the organization have a supported organization described in section 501(c)(4), (5), or (6)? If "Yes," answer lines 3b and 3c below.
3a
 
 
b
Did the organization confirm that each supported organization qualified under section 501(c)(4), (5), or (6) and satisfied the public support tests under section 509(a)(2)? If "Yes," describe in Part VI when and how the organization made the determination.
3b
 
 
c
Did the organization ensure that all support to such organizations was used exclusively for section 170(c)(2)(B) purposes? If "Yes," explain in Part VI what controls the organization put in place to ensure such use.
3c
 
 
4a
Was any supported organization not organized in the United States ("foreign supported organization")? If “Yes” and if you checked box 12a or 12b in Part I, answer lines 4b and 4c below.
4a
 
 
b
Did the organization have ultimate control and discretion in deciding whether to make grants to the foreign supported organization? If “Yes,” describe in Part VI how the organization had such control and discretion despite being controlled or supervised by or in connection with its supported organizations.
4b
 
 
c
Did the organization support any foreign supported organization that does not have an IRS determination under sections 501(c)(3) and 509(a)(1) or (2)? If “Yes,” explain in Part VI what controls the organization used to ensure that all support to the foreign supported organization was used exclusively for section 170(c)(2)(B) purposes.
4c
 
 
5a
Did the organization add, substitute, or remove any supported organizations during the tax year? If “Yes,” answer lines 5b and 5c below (if applicable). Also, provide detail in Part VI, including (i) the names and EIN numbers of the supported organizations added, substituted, or removed; (ii) the reasons for each such action; (iii) the authority under the organization's organizing document authorizing such action; and (iv) how the action was accomplished (such as by amendment to the organizing document).
5a
 
 
b
Type I or Type II only. Was any added or substituted supported organization part of a class already designated in the organization's organizing document?
5b
 
 
c
Substitutions only. Was the substitution the result of an event beyond the organization's control?
5c
 
 
6
Did the organization provide support (whether in the form of grants or the provision of services or facilities) to anyone other than (i) its supported organizations, (ii) individuals that are part of the charitable class benefited by one or more of its supported organizations, or (iii) other supporting organizations that also support or benefit one or more of the filing organization’s supported organizations? If “Yes,” provide detail in Part VI.
6
 
 
7
Did the organization provide a grant, loan, compensation, or other similar payment to a substantial contributor (defined in section 4958(c)(3)(C)), a family member of a substantial contributor, or a 35% controlled entity with regard to a substantial contributor? If “Yes,” complete Part I of Schedule L (Form 990) .
7
 
 
8
Did the organization make a loan to a disqualified person (as defined in section 4958) not described on line 7? If “Yes,” complete Part I of Schedule L (Form 990).
8
 
 
9a
Was the organization controlled directly or indirectly at any time during the tax year by one or more disqualified persons, as defined in section 4946 (other than foundation managers and organizations described in section 509(a)(1) or (2))? If “Yes,” provide detail in Part VI.
9a
 
 
b
Did one or more disqualified persons (as defined on line 9a) hold a controlling interest in any entity in which the supporting organization had an interest? If “Yes,” provide detail in Part VI.
9b
 
 
c
Did a disqualified person (as defined on line 9a) have an ownership interest in, or derive any personal benefit from, assets in which the supporting organization also had an interest? If “Yes,” provide detail in Part VI.
9c
 
 
10a
Was the organization subject to the excess business holdings rules of section 4943 because of section 4943(f) (regarding certain Type II supporting organizations, and all Type III non-functionally integrated supporting organizations)? If “Yes,” answer line 10b below.
10a
 
 
b
Did the organization have any excess business holdings in the tax year? (Use Schedule C, Form 4720, to determine whether the organization had excess business holdings).
10b
 
 
Schedule A (Form 990) 2023

Schedule A (Form 990) 2023
Page 5
Part IV
Supporting Organizations (continued)
Yes
No
11
Has the organization accepted a gift or contribution from any of the following persons?
a
A person who directly or indirectly controls, either alone or together with persons described on lines 11b and 11c below, the governing body of a supported organization?
11a
 
 
b
A family member of a person described on 11a above?
11b
 
 
c
A 35% controlled entity of a person described on line 11a or 11b above? If “Yes” to 11a, 11b, or 11c, provide detail in Part VI.
11c
 
 
Section B. Type I Supporting Organizations
Yes
No
1
Did the officers, directors, trustees, or membership of one or more supported organizations have the power to regularly appoint or elect at least a majority of the organization’s directors or trustees at all times during the tax year? If “No,” describe in Part VI how the supported organization(s) effectively operated, supervised, or controlled the organization’s activities. If the organization had more than one supported organization, describe how the powers to appoint and/or remove directors or trustees were allocated among the supported organizations and what conditions or restrictions, if any, applied to such powers during the tax year.
1
 
 
2
Did the organization operate for the benefit of any supported organization other than the supported organization(s) that operated, supervised, or controlled the supporting organization? If “Yes,” explain in Part VI how providing such benefit carried out the purposes of the supported organization(s) that operated, supervised or controlled the supporting organization.
2
 
 
Section C. Type II Supporting Organizations
Yes
No
1
Were a majority of the organization’s directors or trustees during the tax year also a majority of the directors or trustees of each of the organization’s supported organization(s)? If “No,” describe in Part VI how control or management of the supporting organization was vested in the same persons that controlled or managed the supported organization(s).
1
 
 
Section D. All Type III Supporting Organizations
Yes
No
1
Did the organization provide to each of its supported organizations, by the last day of the fifth month of the organization’s tax year, (i) a written notice describing the type and amount of support provided during the prior tax year, (ii) a copy of the Form 990 that was most recently filed as of the date of notification, and (iii) copies of the organization’s governing documents in effect on the date of notification, to the extent not previously provided?
1
 
 
2
Were any of the organization’s officers, directors, or trustees either (i) appointed or elected by the supported organization(s) or (ii) serving on the governing body of a supported organization? If "No," explain in Part VI how the organization maintained a close and continuous working relationship with the supported organization(s).
2
 
 
3
By reason of the relationship described in line 2 above, did the organization’s supported organizations have a significant voice in the organization’s investment policies and in directing the use of the organization’s income or assets at all times during the tax year? If "Yes," describe in Part VI the role the organization’s supported organizations played in this regard.
3
 
 
Section E. Type III Functionally-Integrated Supporting Organizations
1
Check the box next to the method that the organization used to satisfy the Integral Part Test during the year (see instructions):
a
b
c
2
Activities Test. Answer lines 2a and 2b below.
Yes
No
a
Did substantially all of the organization’s activities during the tax year directly further the exempt purposes of the supported organization(s) to which the organization was responsive? If "Yes," then in Part VI identify those supported organizations and explain how these activities directly furthered their exempt purposes, how the organization was responsive to those supported organizations, and how the organization determined that these activities constituted substantially all of its activities.
2a
 
 
b
Did the activities described on line 2a, above constitute activities that, but for the organization’s involvement, one or more of the organization’s supported organization(s) would have been engaged in? If "Yes," explain in Part VI the reasons for the organization’s position that its supported organization(s) would have engaged in these activities but for the organization’s involvement.
2b
 
 
3
Parent of Supported Organizations. Answer lines 3a and 3b below.
a
Did the organization have the power to regularly appoint or elect a majority of the officers, directors, or trustees of each of the supported organizations?If "Yes" or "No", provide details in Part VI.
3a
 
 
b
Did the organization exercise a substantial degree of direction over the policies, programs and activities of each of its supported organizations? If "Yes," describe in Part VI. the role played by the organization in this regard.
3b
 
 
Schedule A (Form 990) 2023

Schedule A (Form 990) 2023
Page 6
Part V
Type III Non-Functionally Integrated 509(a)(3) Supporting Organizations
1
Check here if the organization satisfied the Integral Part Test as a qualifying trust on Nov. 20, 1970 (explain in Part VI). See instructions. All other Type III non-functionally integrated supporting organizations must complete Sections A through E.
Section A - Adjusted Net Income (A) Prior Year (B) Current Year
(optional)
1 Net short-term capital gain 1    
2 Recoveries of prior-year distributions 2    
3 Other gross income (see instructions) 3    
4 Add lines 1 through 3 4    
5 Depreciation and depletion 5    
6 Portion of operating expenses paid or incurred for production or collection of gross income or for management, conservation, or maintenance of property held for production of income (see instructions) 6    
7 Other expenses (see instructions) 7    
8 Adjusted Net Income (subtract lines 5, 6 and 7 from line 4) 8    
Section B - Minimum Asset Amount (A) Prior Year (B) Current Year
(optional)
1 Aggregate fair market value of all non-exempt-use assets (see instructions for short tax year or assets held for part of year): 1
a Average monthly value of securities 1a    
b Average monthly cash balances 1b    
c Fair market value of other non-exempt-use assets 1c    
d Total (add lines 1a, 1b, and 1c) 1d    
e Discount claimed for blockage or other factors
(explain in detail in Part VI):  
2 Acquisition indebtedness applicable to non-exempt use assets 2    
3 Subtract line 2 from line 1d 3    
4 Cash deemed held for exempt use. Enter 0.015 of line 3 (for greater amount, see instructions). 4    
5 Net value of non-exempt-use assets (subtract line 4 from line 3) 5    
6 Multiply line 5 by 0.035 6    
7 Recoveries of prior-year distributions 7    
8 Minimum Asset Amount (add line 7 to line 6) 8    
Section C - Distributable Amount Current Year
1 Adjusted net income for prior year (from Section A, line 8, Column A) 1  
2 Enter 85% of line 1 2  
3 Minimum asset amount for prior year (from Section B, line 8, Column A) 3  
4 Enter greater of line 2 or line 3 4  
5 Income tax imposed in prior year 5  
6 Distributable Amount. Subtract line 5 from line 4, unless subject to emergency temporary reduction (see instructions) 6  
7
Check here if the current year is the organization's first as a non-functionally-integrated Type III supporting organization (see instructions)
Schedule A (Form 990) 2023

Schedule A (Form 990) 2023
Page 7
Part V
Type III Non-Functionally Integrated 509(a)(3) Supporting Organizations(continued)
Section D - Distributions Current Year
1 Amounts paid to supported organizations to accomplish exempt purposes 1  
2 Amounts paid to perform activity that directly furthers exempt purposes of supported organizations, in
excess of income from activity 		2  
3 Administrative expenses paid to accomplish exempt purposes of supported organizations 3  
4 Amounts paid to acquire exempt-use assets 4  
5 Qualified set-aside amounts (prior IRS approval required - provide details in Part VI) 5  
6 Other distributions (describe in Part VI). See instructions 6  
7Total annual distributions. Add lines 1 through 6. 7  
8 Distributions to attentive supported organizations to which the organization is responsive (provide
details in Part VI). See instructions 		8  
9 Distributable amount for 2023 from Section C, line 6 9  
10 Line 8 amount divided by Line 9 amount 10  
Section E - Distribution Allocations (see instructions) (i)
Excess Distributions 		(ii)
Underdistributions
Pre-2023 		(iii)
Distributable
Amount for 2023
1 Distributable amount for 2023 from Section C, line 6  
2 Underdistributions, if any, for years prior to 2023 (reasonable cause required-- explain in Part VI).
See instructions.		  
3 Excess distributions carryover, if any, to 2023:
a From 2018.......  
b From 2019.......  
c From 2020.......  
d From 2021.......  
e From 2022.......  
fTotal of lines 3a through e  
g Applied to underdistributions of prior years  
h Applied to 2023 distributable amount  
i Carryover from 2018 not applied (see
instructions) 		 
j Remainder. Subtract lines 3g, 3h, and 3i from line 3f.  
4Distributions for 2023 from Section D, line 7:
$  
a Applied to underdistributions of prior years  
b Applied to 2023 distributable amount  
c Remainder. Subtract lines 4a and 4b from line 4.  
5 Remaining underdistributions for years prior to
2023, if any. Subtract lines 3g and 4a from line 2.
If the amount is greater than zero, explain in Part VI.
See instructions. 		 
6 Remaining underdistributions for 2023. Subtract
lines 3h and 4b from line 1. If the amount is greater
than zero, explain in Part VI. See instructions. 		 
7 Excess distributions carryover to 2024. Add lines
3j and 4c. 		 
8 Breakdown of line 7:
a Excess from 2019.....  
b Excess from 2020.....  
c Excess from 2021.....  
d Excess from 2022.....  
e Excess from 2023.....  
Schedule A (Form 990) (2023)

Schedule A (Form 990) 2023
Page 8
Part VI
Supplemental Information. Provide the explanations required by Part II, line 10; Part II, line 17a or 17b; Part III, line 12; Part IV, Section A, lines 1, 2, 3b, 3c, 4b, 4c, 5a, 6, 9a, 9b, 9c, 11a, 11b, and 11c; Part IV, Section B, lines 1 and 2; Part IV, Section C, line 1; Part IV, Section D, lines 2 and 3; Part IV, Section E, lines 1c, 2a, 2b, 3a and 3b; Part V, line 1; Part V, Section B, line 1e; Part V Section D, lines 5, 6, and 8; and Part V, Section E, lines 2, 5, and 6. Also complete this part for any additional information. (See instructions).
Facts And Circumstances Test
 


Return Reference Explanation
Schedule A (Form 990) 2023


Additional Data


Software ID:  
Software Version:  
Schedule B
(Form 990)
Department of the Treasury
Internal Revenue Service
Schedule of Contributors

Arrow Bullet Attach to Form 990, 990-EZ, or 990-PF.
Arrow Bullet Go to www.irs.gov/Form990 for the latest information.
OMB No. 1545-0047
2023
Name of the organization
Avera Health
 
Employer identification number

46-0422673
Organization type (check one):
Filers of:
Section:
Form 990 or 990-EZ






Form 990-PF




Check if your organization is covered by the General Rule or a Special Rule.  
Note: Only a section 501(c)(7), (8), or (10) organization can check boxes for both the General Rule and a Special Rule. See instructions.
General Rule
Special Rules
......... Arrow Bullet $  
Caution: An organization that isn't covered by the General Rule and/or the Special Rules doesn't file Schedule B (Form 990,
990-EZ, or 990-PF), but it must answer “No” on Part IV, line 2, of its Form 990; or check the box on line H of its Form 990-EZ
or on its Form 990PF, Part I, line 2, to certify that it doesn't meet the filing requirements of Schedule B (Form 990,
990-EZ, or 990-PF).
For Paperwork Reduction Act Notice, see the Instructions
for Form 990, 990-EZ, or 990-PF.
Cat. No. 30613XSchedule B (Form 990) (2023)
Schedule B (Form 990) (2023) Page 2
Name of organization
Avera Health
  		Employer identification number
46-0422673
Part I
Contributors
Contributors (see instructions). Use duplicate copies of Part I if additional space is needed.
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total contributions		 (d)
Type of contribution
RESTRICTED
 
 
 
 
  ,    

$ RESTRICTED


(Complete Part II for noncash contributions.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total contributions		 (d)
Type of contribution
 
 
 
 

$  


(Complete Part II for noncash contributions.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total contributions		 (d)
Type of contribution
 
 
 
 

$  


(Complete Part II for noncash contributions.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total contributions		 (d)
Type of contribution
 
 
 
 

$  


(Complete Part II for noncash contributions.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total contributions		 (d)
Type of contribution
 
 
 
 

$  


(Complete Part II for noncash contributions.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total contributions		 (d)
Type of contribution
 
 
 
 

$  


(Complete Part II for noncash contributions.)
Schedule B (Form 990) (2023)
Schedule B (Form 990) (2023)
Page 3
Name of organization
Avera Health
  		Employer identification number

46-0422673
Part II
Noncash Property (see instructions). Use duplicate copies of Part II if additional space is needed.
(a)
No. from Part I 		(b)
Description of noncash property given 		(c)
FMV (or estimate)
(See instructions) 		(d)
Date received
 
$    
(a)
No. from Part I 		(b)
Description of noncash property given 		(c)
FMV (or estimate)
(See instructions) 		(d)
Date received
 
$    
(a)
No. from Part I 		(b)
Description of noncash property given 		(c)
FMV (or estimate)
(See instructions) 		(d)
Date received
 
$    
(a)
No. from Part I 		(b)
Description of noncash property given 		(c)
FMV (or estimate)
(See instructions) 		(d)
Date received
 
$    
(a)
No. from Part I 		(b)
Description of noncash property given 		(c)
FMV (or estimate)
(See instructions) 		(d)
Date received
 
$    
(a)
No. from Part I 		(b)
Description of noncash property given 		(c)
FMV (or estimate)
(See instructions) 		(d)
Date received
 
$    
Schedule B (Form 990) (2023)
Schedule B (Form 990) (2023)
Page 4
Name of organization
Avera Health
  		Employer identification number

46-0422673
Part III
Exclusively religious, charitable, etc., contributions to organizations described in section 501(c)(7), (8), or (10) that total more than $1,000 for the year from any one contributor. Complete columns (a) through (e) and the following line entry. For organizations completing Part III, enter the total of exclusively religious, charitable, etc., contributions of $1,000 or less for the year. (Enter this information once. See instructions.) Arrow Bullet$  
Use duplicate copies of Part III if additional space is needed.
(a)
No. from Part I		 (b) Purpose of gift (c) Use of gift (d) Description of how gift is held
 
(e) Transfer of gift
Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
 
 
     
 
(a)
No. from Part I		 (b) Purpose of gift (c) Use of gift (d) Description of how gift is held
 
(e) Transfer of gift
Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
 
 
     
 
(a)
No. from Part I		 (b) Purpose of gift (c) Use of gift (d) Description of how gift is held
 
(e) Transfer of gift
Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
 
 
     
 
(a)
No. from Part I		 (b) Purpose of gift (c) Use of gift (d) Description of how gift is held
 
(e) Transfer of gift
Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
 
 
     
 
Schedule B (Form 990) (2023)
Additional Data


Software ID:  
Software Version:  
SCHEDULE C
(Form 990)

Department of the Treasury
Internal Revenue Service
Political Campaign and Lobbying Activities

For Organizations Exempt From Income Tax Under section 501(c) and section 527

right arrow Complete if the organization is described below. right arrow Attach to Form 990 or Form 990-EZ.
right arrowGo to www.irs.gov/Form990 for instructions and the latest information.
OMB No. 1545-0047
2022
Open to Public
Inspection
If the organization answered "Yes" on Form 990, Part IV, Line 3, or Form 990-EZ, Part V, line 46 (Political Campaign Activities), then
Round Bullet Section 501(c)(3) organizations: Complete Parts I-A and B. Do not complete Part I-C.
Round Bullet Section 501(c) (other than section 501(c)(3)) organizations: Complete Parts I-A and C below. Do not complete Part I-B.
Round Bullet Section 527 organizations: Complete Part I-A only.
If the organization answered "Yes" on Form 990, Part IV, Line 4, or Form 990-EZ, Part VI, line 47 (Lobbying Activities), then
Round Bullet Section 501(c)(3) organizations that have filed Form 5768 (election under section 501(h)): Complete Part II-A. Do not complete Part II-B.
Round Bullet Section 501(c)(3) organizations that have NOT filed Form 5768 (election under section 501(h)): Complete Part II-B. Do not complete Part II-A.
If the organization answered "Yes" on Form 990, Part IV, Line 5 (Proxy Tax) (see separate instructions) or Form 990-EZ, Part V, line 35c (Proxy Tax) (see separate instructions), then
Round Bullet Section 501(c)(4), (5), or (6) organizations: Complete Part III.
Name of the organization
Avera Health
 
Employer identification number

46-0422673
Part I-A
Complete if the organization is exempt under section 501(c) or is a section 527 organization.

1
Provide a description of the organization’s direct and indirect political campaign activities in Part IV. See instructions for definition of “political campaign activities."

2
Political campaign activity expenditures. See instructions ....................................................................right arrow
$  
3
Volunteer hours for political campaign activities. See instructions ..................................................................
 

Part I-B
Complete if the organization is exempt under section 501(c)(3).
1
Enter the amount of any excise tax incurred by the organization under section 4955 ................................right arrow
$  
2
Enter the amount of any excise tax incurred by organization managers under section 4955 .......................right arrow
$  
3
If the organization incurred a section 4955 tax, did it file Form 4720 for this year? .........................................
4a
Was a correction made? ......................................................................................................................
b
If "Yes," describe in Part IV.
Part I-C
Complete if the organization is exempt under section 501(c), except section 501(c)(3).
1
Enter the amount directly expended by the filing organization for section 527 exempt function activities ..... right arrow
$  
2
Enter the amount of the filing organization's funds contributed to other organizations for section 527 exempt function activities ............................................................................................................................right arrow

$  
3
Total exempt function expenditures. Add lines 1 and 2. Enter here and on Form 1120-POL, line 17b...........right arrow

$  
4
Did the filing organization file Form 1120-POL for this year? ...................................................................
5
Enter the names, addresses and employer identification number (EIN) of all section 527 political organizations to which the filing
organization made payments. For each organization listed, enter the amount paid from the filing organization’s funds. Also enter the amount of political contributions received that were promptly and directly delivered to a separate political organization, such as a separate segregated fund or a political action committee (PAC). If additional space is needed, provide information in Part IV.
(a) Name (b) Address (c) EIN (d) Amount paid from filing organization's funds. If none, enter -0-. (e) Amount of political contributions received and promptly and directly delivered to a separate political organization. If none, enter -0-.
1
2
3
4
5
6
For Paperwork Reduction Act Notice, see the instructions for Form 990.
Cat. No. 50084S
Schedule C (Form 990) 2022

Schedule C (Form 990) 2022
Page 2
Part II-A
Complete if the organization is exempt under section 501(c)(3) and filed Form 5768 (election under section 501(h)).
A Check right arrowexpenses, and share of excess lobbying expenditures).
B Check right arrow
Limits on Lobbying Expenditures
(The term "expenditures" means amounts paid or incurred.) 		(a) Filing
organization's
totals 		(b) Affiliated group totals
1a Total lobbying expenditures to influence public opinion (grass roots lobbying) ......................    
b Total lobbying expenditures to influence a legislative body (direct lobbying) ........................    
c Total lobbying expenditures (add lines 1a and 1b) ............................................................    
d Other exempt purpose expenditures ...............................................................................    
e Total exempt purpose expenditures (add lines 1c and 1d) ..................................................    
f Lobbying nontaxable amount. Enter the amount from the following table in both
columns.		    
If the amount on line 1e, column (a) or (b) is:The lobbying nontaxable amount is:
Not over $500,00020% of the amount on line 1e.
Over $500,000 but not over $1,000,000$100,000 plus 15% of the excess over $500,000.
Over $1,000,000 but not over $1,500,000$175,000 plus 10% of the excess over $1,000,000.
Over $1,500,000 but not over $17,000,000$225,000 plus 5% of the excess over $1,500,000.
Over $17,000,000$1,000,000.
g Grassroots nontaxable amount (enter 25% of line 1f) .................................................    
h Subtract line 1g from line 1a. If zero or less, enter -0-. ................................................    
i Subtract line 1f from line 1c. If zero or less, enter -0-. ................................................    
j If there is an amount other than zero on either line 1h or line 1i, did the organization file Form 4720 reporting
section 4911 tax for this year? ...................................................................................................................

4-Year Averaging Period Under Section 501(h)
(Some organizations that made a section 501(h) election do not have to complete all of the five
columns below. See the separate instructions for lines 2a through 2f.)
Lobbying Expenditures During 4-Year Averaging Period
Calendar year (or fiscal year
beginning in) 		(a) 2019 (b) 2020 (c) 2021 (d) 2022 (e) Total
2a Lobbying nontaxable amount          
b Lobbying ceiling amount
(150% of line 2a, column(e)) 		 
c Total lobbying expenditures          
d Grassroots nontaxable amount          
e Grassroots ceiling amount
(150% of line 2d, column (e))		  
f Grassroots lobbying expenditures          
Schedule C (Form 990) 2022


Schedule C (Form 990) 2022
Page 3
Part II-B
Complete if the organization is exempt under section 501(c)(3) and has NOT filed Form 5768 (election under section 501(h)).
For each "Yes" response on lines 1a through 1i below, provide in Part IV a detailed description of the lobbying activity.
(a)
Yes|No
(b)
Amount
1
During the year, did the filing organization attempt to influence foreign, national, state or local legislation, including any attempt to influence public opinion on a legislative matter or referendum, through the use of:
a
Volunteers? ...........................................................................................................
 
No
b
Paid staff or management (include compensation in expenses reported on lines 1c through 1i)? ........
Yes
 
c
Media advertisements? ...................................................................................................
 
No
 
d
Mailings to members, legislators, or the public? .............................................................................
 
No
 
e
Publications, or published or broadcast statements? ...........................................................
 
No
 
f
Grants to other organizations for lobbying purposes? ..........................................................
 
No
 
g
Direct contact with legislators, their staffs, government officials, or a legislative body? .......................
Yes
 
2,389
h
Rallies, demonstrations, seminars, conventions, speeches, lectures, or any similar means? ..................
 
No
 
i
Other activities? ...................................................................................................................
Yes
 
151,877
j
Total. Add lines 1c through 1i ....................................................................................................
154,266
2a
Did the activities in line 1 cause the organization to be not described in section 501(c)(3)? .....
 
No
b
If "Yes," enter the amount of any tax incurred under section 4912 ...........................................
 
c
If "Yes," enter the amount of any tax incurred by organization managers under section 4912 ...................
 
d
If the filing organization incurred a section 4912 tax, did it file Form 4720 for this year? ........................
 
 
Part III-A
Complete if the organization is exempt under section 501(c)(4), section 501(c)(5), or section 501(c)(6).
Yes
No
1
Were substantially all (90% or more) dues received nondeductible by members? ...............................................
1
 
 
2
Did the organization make only in-house lobbying expenditures of $2,000 or less? ............................................
2
 
 
3
Did the organization agree to carry over lobbying and political expenditures from the prior year? .................................
3
 
 
Part III-B
Complete if the organization is exempt under section 501(c)(4), section 501(c)(5), or section 501(c)(6) and if either (a) BOTH Part III-A, lines 1 and 2, are answered "No" OR (b) Part III-A, line 3, is answered “Yes."
1
Dues, assessments and similar amounts from members ......................................................................
1
 
2
Section 162(e) nondeductible lobbying and political expenditures (do not include amounts of political expenses for which the section 527(f) tax was paid).
a
Current year .............................................................................................................................
2a
 
b
Carryover from last year ............................................................................................................
2b
 
c
Total ...........................................................................................................................................
2c
 
3
Aggregate amount reported in section 6033(e)(1)(A) notices of nondeductible section 162(e) dues .
3
 
4
If notices were sent and the amount on line 2c exceeds the amount on line 3, what portion of the excess does the organization agree to carryover to the reasonable estimate of nondeductible lobbying and political expenditure next year? ......................................................................................................................
4
 
5
Taxable amount of lobbying and political expenditures. See Instructions .........................................
5
 
Part IV
Supplemental Information
Provide the descriptions required for Part l-A, line 1; Part l-B, line 4; Part l-C, line 5; Part II-A (affiliated group list); Part II-A, lines 1 and 2 (see instructions), and Part ll-B, line 1. Also, complete this part for any additional information.
Return Reference Explanation
Part II-B, Line 1: 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.
Schedule C (Form 990) 2022


Additional Data


Software ID:  
Software Version:  

SCHEDULE D
(Form 990)
Department of the Treasury
Internal Revenue Service
Supplemental Financial Statements
right arrow Complete if the organization answered "Yes," on Form 990,
Part IV, line 6, 7, 8, 9, 10, 11a, 11b, 11c, 11d, 11e, 11f, 12a, or 12b.
right arrow Attach to Form 990.
right arrow Go to www.irs.gov/Form990 for instructions and the latest information.
OMB No. 1545-0047
2022
Open to Public Inspection
Name of the organization
Avera Health
 
Employer identification number

46-0422673
Part I
Organizations Maintaining Donor Advised Funds or Other Similar Funds or Accounts. Complete if the organization answered "Yes" on Form 990, Part IV, line 6.
(a) Donor advised funds (b) Funds and other accounts
1 Total number at end of year .........    
2 Aggregate value of contributions to (during year)    
3 Aggregate value of grants from (during year)    
4 Aggregate value at end of year ........    
5
Did the organization inform all donors and donor advisors in writing that the assets held in donor advised funds are the organization’s property, subject to the organization’s exclusive legal control? ............
6
Did the organization inform all grantees, donors, and donor advisors in writing that grant funds can be used only for charitable purposes and not for the benefit of the donor or donor advisor, or for any other purpose conferring impermissible private benefit? ...................................
Part II
Conservation Easements.
Complete if the organization answered "Yes" on Form 990, Part IV, line 7.
1
Purpose(s) of conservation easements held by the organization (check all that apply).
2
Complete lines 2a through 2d if the organization held a qualified conservation contribution in the form of a conservation easement on the last day of the tax year.
Held at the End of the Year
a Total number of conservation easements ...................... 2a  
b Total acreage restricted by conservation easements .................... 2b  
c Number of conservation easements on a certified historic structure included in (a) ..... 2c  
d Number of conservation easements included in (c) acquired after July 25, 2006, and not on a historic structure listed in the National Register ... 2d  
3
Number of conservation easements modified, transferred, released, extinguished, or terminated by the organization during the
tax year right arrow  
4
Number of states where property subject to conservation easement is located right arrow  
5
Does the organization have a written policy regarding the periodic monitoring, inspection, handling of violations, and enforcement of the conservation easements it holds? ............
6
Staff and volunteer hours devoted to monitoring, inspecting, handling of violations, and enforcing conservation easements during the year
right arrow  
7
Amount of expenses incurred in monitoring, inspecting, handling of violations, and enforcing conservation easements during the year
right arrow $  
8
Does each conservation easement reported on line 2(d) above satisfy the requirements of section 170(h)(4)(B)(i) and section 170(h)(4)(B)(ii)? .............................
9
In Part XIII, describe how the organization reports conservation easements in its revenue and expense statement, and
balance sheet, and include, if applicable, the text of the footnote to the organization’s financial statements that describes
the organization’s accounting for conservation easements.
Part III
Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets.
Complete if the organization answered "Yes" on Form 990, Part IV, line 8.
1a
If the organization elected, as permitted under FASB ASC 958, not to report in its revenue statement and balance sheet works of art, historical treasures, or other similar assets held for public exhibition, education, or research in furtherance of public service, provide, in Part XIII, the text of the footnote to its financial statements that describes these items.
b
If the organization elected, as permitted under FASB ASC 958, to report in its revenue statement and balance sheet works of art, historical treasures, or other similar assets held for public exhibition, education, or research in furtherance of public service, provide the following amounts relating to these items:
(i)
Revenue included on Form 990, Part VIII, line 1 .........................right arrow $  
(ii)
Assets included in Form 990, Part X ...............................right arrow $  
2
If the organization received or held works of art, historical treasures, or other similar assets for financial gain, provide the
following amounts required to be reported under FASB ASC 958 relating to these items:
a
Revenue included on Form 990, Part VIII, line 1 ..........................right arrow $  
b
Assets included in Form 990, Part X ...............................right arrow $  
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 52283D
Schedule D (Form 990) 2022

Schedule D (Form 990) 2022
Page 2
Part III
Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets (continued)
3
Using the organization’s acquisition, accession, and other records, check any of the following that are a significant use of its collection items (check all that apply):
a
d
b
e
 
c
4
Provide a description of the organization’s collections and explain how they further the organization’s exempt purpose in
Part XIII.
5
During the year, did the organization solicit or receive donations of art, historical treasures or other similar
assets to be sold to raise funds rather than to be maintained as part of the organization’s collection?...
Part IV
Escrow and Custodial Arrangements. Complete if the organization answered "Yes" on Form 990, Part IV, line 9, or reported an amount on Form 990, Part X, line 21.
1a
Is the organization an agent, trustee, custodian or other intermediary for contributions or other assets not
included on Form 990, Part X? ....................................
b If "Yes," explain the arrangement in Part XIII and complete the following table: Amount
c Beginning balance ............................. 1c  
d Additions during the year ............................ 1d  
e Distributions during the year .......................... 1e  
f Ending balance ................................ 1f  
2a
Did the organization include an amount on Form 990, Part X, line 21, for escrow or custodial account liability? ...
b
If "Yes," explain the arrangement in Part XIII. Check here if the explanation has been provided in Part XIII ....
Part V
Endowment Funds.
Complete if the organization answered "Yes" on Form 990, Part IV, line 10.
(a) Current year (b) Prior year (c) Two years back (d) Three years back (e) Four years back
1a Beginning of year balance .... 19,295,442 20,349,540 7,798,048 6,403,165 5,765,277
b Contributions ... 1,301,057 829,430 12,909,313 1,694,590 820,309
c Net investment earnings, gains, and losses -1,419,368 141,193 136,229 432,897 128,114
d Grants or scholarships ...          
e Other expenditures for facilities
and programs ... 		1,062,186 1,977,165 450,181 696,359 273,739
f Administrative expenses .... 58,770 47,556 43,869 36,245 36,796
g End of year balance ...... 18,056,175 19,295,442 20,349,540 7,798,048 6,403,165
2
Provide the estimated percentage of the current year end balance (line 1g, column (a)) held as:
a
Board designated or quasi-endowment right arrow15.520 %
b
Permanent endowment right arrow6.310 %
c
Term endowment right arrow78.170 %
The percentages on lines 2a, 2b, and 2c should equal 100%.
3a
Are there endowment funds not in the possession of the organization that are held and administered for the
organization by:

Yes
No
(i) Unrelated organizations .................
3a(i)
 
No
(ii) Related organizations .................
3a(ii)
 
No
b
If "Yes" on 3a(ii), are the related organizations listed as required on Schedule R? .........
3b
 
 
4
Describe in Part XIII the intended uses of the organization's endowment funds.
Part VI
Land, Buildings, and Equipment.
Complete if the organization answered "Yes" on Form 990, Part IV, line 11a. See Form 990, Part X, line 10.
Description of property (a) Cost or other basis
(investment) 		(b) Cost or other basis (other) (c) Accumulated depreciation (d) Book value
1a Land .....   948,600 948,600
b Buildings ....   32,005,994 13,783,076 18,222,918
c Leasehold improvements   4,297,610 2,079,292 2,218,318
d Equipment ....   216,271,808 154,789,966 61,481,842
e Other .....   14,896,724   14,896,724
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).)..right arrow 97,768,402
Schedule D (Form 990) 2022

Schedule D (Form 990) 2022
Page 3
Part VII
Investments - Other Securities.
Complete if the organization answered "Yes" on Form 990, Part IV, line 11b. See Form 990, Part X, line 12.
(a) Description of security or category
(including name of security)		 (b) Book value (c) Method of valuation:
Cost or end-of-year market value
(1) Financial derivatives.........    
(2) Closely-held equity interests........    
(3) Other
(A) Interest in Innovation Institute		 10,201,824 F

(B) Non-publicly traded hedge, private equity, debt, and multi-strategy funds		 114,717,069 F

(C) Non-publicly traded real estate		 11,731,656 F

(D) NPPC, LLC		 100,000 C
(D)
(E)
(F)
(G)
(H)
Total. (Column (b) must equal Form 990, Part X, col. (B) line 12.)right arrow 136,750,549
Part VIII
Investments - Program Related. Complete if the organization answered 'Yes' on Form 990, Part IV, line 11c. See Form 990, Part X, line 13.
(a) Description of investment (b) Book value (c) Method of valuation:
Cost or end-of-year market value
(1)
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 13.)right arrow  
Part IX
Other Assets.
Complete if the organization answered 'Yes' on Form 990, Part IV, line 11d. See Form 990, Part X, line 15.
(a) Description (b) Book value
(1)Deferred financing costs 13,084,609
(2)Interest in South Dakota Community Foundation 1,277,324
(3)Deferred compensation 116,427,304
(4)Right of use operating lease 3,984,107
(5)Cash surrender value of life insurance policies 2,909,167
(5)
(6)
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 15.)...........right arrow 137,682,511
Part X
Other Liabilities.
Complete if the organization answered 'Yes' on Form 990, Part IV, line 11e or 11f. See Form 990, Part X, line 25.
1.(a) Description of liability (b) Book value
(1) Federal income taxes  
Estimated insurance claims payable 27,775,266
Bond interest payable 9,383,754
Due to affiliated entities 175,925,833
Deferred compensation 211,284,478
Long-term commitments 9,182,919
Right of use lease obligations 4,118,906
Other liabilities 216,734


Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)right arrow 437,887,890
2. Liability for uncertain tax positions. In Part XIII, provide the text of the footnote to the organization's financial statements that reports the organization's liability for uncertain tax positions under FIN 48 (ASC 740). Check here if the text of the footnote has been provided in Part XIII
Schedule D (Form 990) 2022

Schedule D (Form 990) 2022
Page 4
Part XI Reconciliation of Revenue per Audited Financial Statements With Revenue per Return. Complete if the organization answered 'Yes' on Form 990, Part IV, line 12a.
1 Total revenue, gains, and other support per audited financial statements ....... 1  
2 Amounts included on line 1 but not on Form 990, Part VIII, line 12:
a Net unrealized gains (losses) on investments .... 2a  
b Donated services and use of facilities ......... 2b  
c Recoveries of prior year grants ........... 2c  
d Other (Describe in Part XIII.) ........... 2d  
e Add lines 2a through 2d ..................... 2e  
3 Subtract line 2e from line 1.................. 3  
4 Amounts included on Form 990, Part VIII, line 12, but not on line 1:
a Investment expenses not included on Form 990, Part VIII, line 7b . 4a  
b Other (Describe in Part XIII.) ........... 4b  
c Add lines 4a and 4b.................... 4c  
5 Total revenue. Add lines 3 and 4c. (This must equal Form 990, Part I, line 12.) ...... 5  
Part XII Reconciliation of Expenses per Audited Financial Statements With Expenses per Return. Complete if the organization answered 'Yes' on Form 990, Part IV, line 12a.
1 Total expenses and losses per audited financial statements ........... 1  
2 Amounts included on line 1 but not on Form 990, Part IX, line 25:
a Donated services and use of facilities ......... 2a  
b Prior year adjustments ............ 2b  
c Other losses ................ 2c  
d Other (Describe in Part XIII.) ........... 2d  
e Add lines 2a through 2d.................... 2e  
3 Subtract line 2e from line 1................... 3  
4 Amounts included on Form 990, Part IX, line 25, but not on line 1:
a Investment expenses not included on Form 990, Part VIII, line 7b .. 4a  
b Other (Describe in Part XIII.) ........... 4b  
c Add lines 4a and 4b..................... 4c  
5 Total expenses. Add lines 3 and 4c. (This must equal Form 990, Part I, line 18.) ...... 5  
Part XIII
Supplemental Information
Provide the descriptions required for Part II, lines 3, 5, and 9; Part III, lines 1a and 4; Part lV, lines 1b and 2b; Part V, line 4; Part X, line 2; Part XI, lines 2d and 4b; and Part XII, lines 2d and 4b. Also complete this part to provide any additional information.
Return Reference Explanation
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 D (Form 990) 2022


Additional Data


Software ID:  
Software Version:  




SCHEDULE F(Form 990)
Department of the Treasury
Internal Revenue Service
Statement of Activities Outside the United States
Right arrow Complete if the organization answered "Yes" to Form 990, Part IV, line 14b, 15, or 16.Right arrow Attach to Form 990.Right arrow Go to www.irs.gov/Form990 for instructions and the latest information.
OMB No. 1545-0047
2023
Open to Public Inspection
Name of the organization
Avera Health
 
Employer identification number

46-0422673
Part I
General Information on Activities Outside the United States. Complete if the organization answered "Yes" on Form 990, Part IV, line 14b.
1
For grantmakers. Does the organization maintain records to substantiate the amount of its grants and
other assistance, the grantees’ eligibility for the grants or assistance, and the selection criteria used
to award the grants or assistance? . . . . . . . . . . . . . . . . . . . . . . . . .
2
For grantmakers. Describe in Part V the organization’s procedures for monitoring the use of its grants and other assistance outside the United States.
3
Activites per Region. (The following Part I, line 3 table can be duplicated if additional space is needed.)
(a) Region (b) Number of offices in the region (c) Number of employees, agents, and independent contractors in the region (d) Activities conducted in region (by type) (such as, fundraising, program services, investments, grants to recipients located in the region) (e) If activity listed in (d) is a program service, describe specific type of
service(s) in the region		 (f) Total expenditures
for and investments
in the region
Central America and the Caribbean - 0 0 Investments   114,717,000
           
           
           
           
           
           
           
           
           
           
           
           
           
           
           
           
3a Sub-total .... 0 0 114,717,000
b Total from continuation sheets to Part I ... 0 0 0
c Totals (add lines 3a and 3b) 0 0 114,717,000
For Paperwork Reduction Act Notice, see the Instructions for Form 990.Cat. No. 50082W Schedule F (Form 990) 2023
Schedule F (Form 990) 2023
Page 2
Part II
Grants and Other Assistance to Organizations or Entities Outside the United States. Complete if the organization answered "Yes" on Form 990, Part IV, line 15, for any recipient who received more than $5,000. Part II can be duplicated if additional space is needed.
1 (a) Name of organization (b) IRS code section
and EIN (if applicable)		 (c) Region (d) Purpose of
grant 		(e) Amount of
cash grant 		(f) Manner of
cash
disbursement 		(g) Amount
of noncash
assistance 		(h) Description
of noncash
assistance 		(i) Method of
valuation
(book, FMV,
appraisal, other)
             
             
             
             
             
             
             
             
             
             
             
             
             
             
             
             
2 Enter total number of recipient organizations listed above that are recognized as charities by the foreign country, recognized as tax-exempt by the IRS, or for which the grantee or counsel has provided a section 501(c)(3) equivalency letter .......MediumBullet
 
3 Enter total number of other organizations or entities .......................MediumBullet
 
Schedule F (Form 990) 2023
Schedule F (Form 990) 2023Page 3
Part III
Grants and Other Assistance to Individuals Outside the United States. Complete if the organization answered "Yes" on Form 990, Part IV, line 16.
Part III can be duplicated if additional space is needed.
(a) Type of grant or assistance (b) Region (c) Number of recipients (d) Amount of
cash grant 		(e) Manner of cash
disbursement 		(f) Amount of
noncash
assistance 		(g) Description
of noncash
assistance 		(h) Method of
valuation
(book, FMV,
appraisal, other)
               
               
               
               
               
               
               
               
               
               
               
               
               
               
               
               
               
               
Schedule F (Form 990) 2023
Schedule F (Form 990) 2023
Page 4
Part IV
Foreign Forms
1 Was the organization a U.S. transferor of property to a foreign corporation during the tax year? If "Yes," the organization may be required to file Form 926, Return by a U.S. Transferor of Property to a Foreign Corporation (see Instructions for Form 926). . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
2 Did the organization have an interest in a foreign trust during the tax year? If "Yes," the organization may be required to separately file Form 3520, Annual Return to Report Transactions with Foreign Trusts and Receipt of Certain Foreign Gifts, and/or Form 3520-A, Annual Information Return of Foreign Trust With a U.S. Owner (see Instructions for Forms 3520 and 3520-A; don't file with Form 990). . . . . . . . . . . . . . . . . . . . . . . .
3 Did the organization have an ownership interest in a foreign corporation during the tax year? If "Yes," the organization may be required to file Form 5471, Information Return of U.S. Persons with Respect to Certain Foreign Corporations. (see Instructions for Form 5471). . . . . . . . . . . . . . . . . . . . . . . . . . . .
4 Was the organization a direct or indirect shareholder of a passive foreign investment company or a qualified electing fund during the tax year? If “Yes,” the organization may be required to file Form 8621, Information Return by a Shareholder of a Passive Foreign Investment Company or Qualified Electing Fund. (see Instructions for Form 8621) .
5 Did the organization have an ownership interest in a foreign partnership during the tax year? If "Yes," the organization may be required to file Form 8865, Return of U.S. Persons with Respect to Certain Foreign Partnerships (see Instructions for Form 8865). . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
6 Did the organization have any operations in or related to any boycotting countries during the tax year? If "Yes," the organization may be required to separately file Form 5713, International Boycott Report (see Instructions for Form 5713; don't file with Form 990).. . . . . . . . . . . . . . . . . . . . . . . . . . . .
Schedule F (Form 990) 2023
Schedule F (Form 990) 2023
Page 5
Part V
Supplemental Information
Provide the information required by Part I, line 2 (monitoring of funds); Part I, line 3, column (f) (accounting method; amounts of investments vs. expenditures per region); Part II, line 1 (accounting method); Part III (accounting method); and Part III, column (c) (estimated number of recipients), as applicable. Also complete this part to provide any additional information. See instructions.
ReturnReference Explanation
Schedule F, Part I line 3(f) Due to software limitations, the amount on line 3(f) is not printing correctly. The amount is $114,717,000.
Form 990, Schedule F, Part IV: 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.
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
Schedule F (Form 990) 2023
Additional Data


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Software Version:  



SCHEDULE G (Form 990)
Department of the Treasury
Internal Revenue Service
Supplemental Information Regarding
Fundraising or Gaming Activities
Complete if the organization answered "Yes" on Form 990, Part IV, lines 17, 18, or 19, or if the organization entered more than $15,000 on Form 990-EZ, line 6a. right arrowAttach to Form 990 or Form 990-EZ.
right arrowGo to www.irs.gov/Form990 for instructions and the latest information.
OMB No. 1545-0047
2023
Open to Public Inspection
Name of the organization
Avera Health
 
Employer identification number

46-0422673
Part I
Fundraising Activities.Complete if the organization answered "Yes" on Form 990, Part IV, line 17.
Form 990-EZ filers are not required to complete this part.
1
Indicate whether the organization raised funds through any of the following activities. Check all that apply.
a e
b f
c g
d
2a
Did the organization have a written or oral agreement with any individual (including officers, directors, trustees
or key employees listed in Form 990, Part VII) or entity in connection with professional fundraising services?
b
If "Yes," list the 10 highest paid individuals or entities (fundraisers) pursuant to agreements under which the fundraiser is
to be compensated at least $5,000 by the organization.


(i) Name and address of individual
or entity (fundraiser) 		(ii) Activity (iii) Did fundraiser have custody or control of contributions? (iv) Gross receipts
from activity 		(v) Amount paid to
(or retained by)
fundraiser listed in
col. (i) 		(vi) Amount paid to
(or retained by)
organization
Yes No
             
             
             
             
             
             
             
             
             
             
Total . . . . . . . . . . . . . . . . . . . . right arrow      
3
List all states in which the organization is registered or licensed to solicit contributions or has been notified it is exempt from registration or licensing.
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.
Cat. No. 50083H
Schedule G (Form 990) 2023
Schedule G (Form 990) 2023
Page 2
Part II
Fundraising Events. Complete if the organization answered "Yes" on Form 990, Part IV, line 18, or reported more than $15,000 of fundraising event contributions and gross income on Form 990-EZ, lines 1 and 6b. List events with gross receipts greater than $5,000.









VerticalRevenue
(a) Event #1

Avera Race Against Cancer
(event type) 		(b) Event #2

Hearts in Healing
(event type) 		(c) Other events

18
(total number) 		(d) Total events
(add col. (a) through col. (c))

1
Gross receipts . . . . .
808,601
240,912
832,420
1,881,933

2
Less: Contributions . . . .
499,204
180,092
47,352
726,648
3 Gross income (line 1 minus
line 2) . . . . . .
309,397
60,820
785,068
1,155,285



VerticalDirectExpenses
4 Cash prizes . . . . .        
5 Noncash prizes . . . . 918     918
6 Rent/facility costs . . . . 40,519 6,518 1,812 48,849
7 Food and beverages . . . 3,764 7,654 94,783 106,201
8 Entertainment . . . . 18,765 6,600 22,820 48,185
9 Other direct expenses . . . 5,130     5,130
10 Direct expense summary. Add lines 4 through 9 in column (d) . . . . . . . . . . right arrow 209,283
11 Net income summary. Subtract line 10 from line 3, column (d). . . . . . . . . . right arrow 946,002
Part III
Gaming. Complete if the organization answered "Yes" on Form 990, Part IV, line 19, or reported more than $15,000 on Form 990-EZ, line 6a.
VerticalRevenue
(a) Bingo (b) Pull tabs/Instant
bingo/progressive bingo 		(c) Other gaming (d) Total gaming (add col.(a) through col.(c))

1
Gross revenue . . . . .
 
 
 
 
VerticalDirectExpenses

2
Cash prizes . . . . .
 
 
 
 

3
Noncash prizes . . . .
 
 
 
 

4
Rent/facility costs . . . .
 
 
 
 

5
Other direct expenses . . .
 
 
 
 


6

Volunteer labor . . . .
%
%
%


7
Direct expense summary. Add lines 2 through 5 in column (d) . . . . . . . . . . right arrow
 

8
Net gaming income summary. Subtract line 7 from line 1, column (d). . . . . . . . . right arrow
 

9
Enter the state(s) in which the organization conducts gaming activities:
a
Is the organization licensed to conduct gaming activities in each of these states? . . . . . . . .
YesNo
b
If "No," explain:
 
10a
Were any of the organization's gaming licenses revoked, suspended or terminated during the tax year? . . .
YesNo
b
If "Yes," explain:
 
Schedule G (Form 990) 2023
Schedule G (Form 990) 2023
Page 3
11
Does the organization conduct gaming activities with nonmembers? . . . . . . . . . . .
YesNo
12
Is the organization a grantor, beneficiary or trustee of a trust or a member of a partnership or other entity
formed to administer charitable gaming? . . . . . . . . . . . . . . . . .
YesNo
13
Indicate the percentage of gaming activity conducted in:
a
The organization's facility . . . . . . . . . . . . . . . . . .
13a
%
b
An outside facility . . . . . . . . . . . . . . . . . . . .
13b
%
14
Enter the name and address of the person who prepares the organization's gaming/special events books and records:
Name right arrow
Address right arrow
15a
Does the organization have a contract with a third party from whom the organization receives gaming
revenue? . . . . . . . . . . . . . . . . . . . . . . . .
b
If "Yes," enter the amount of gaming revenue received by the organization right arrow $   and the
amount of gaming revenue retained by the third party right arrow $   .
c
If "Yes," enter name and address of the third party:
Name right arrow
Address right arrow
16
Gaming manager information:
Name right arrow
Gaming manager compensation right arrow $  
Description of services provided right arrow
 
17
Mandatory distributions:
a
Is the organization required under state law to make charitable distributions from the gaming proceeds to
retain the state gaming license? . . . . . . . . . . . . . . . . . . .
b
Enter the amount of distributions required under state law distributed to other exempt organizations or spent
in the organization's own exempt activities during the tax year right arrow$  
Part IV
Supplemental Information. Provide the explanations required by Part I, line 2b, columns (iii) and (v); and Part III, lines 9, 9b, 10b, 15b, 15c, 16, and 17b, as applicable. Also provide any additional information. See instructions.
Return Reference Explanation
Schedule G (Form 990) 2023
Additional Data


Software ID:  
Software Version:  

Note: To capture the full content of this document, please select landscape mode (11" x 8.5") when printing.

Schedule I
(Form 990)
Department of the Treasury
Internal Revenue Service
Grants and Other Assistance to Organizations,
Governments and Individuals in the United States
Complete if the organization answered "Yes," on Form 990, Part IV, line 21 or 22.
lBullet Attach to Form 990.
lBullet Go to www.irs.gov/Form990 for the latest information.
OMB No. 1545-0047
2023
Open to Public
Inspection
Name of the organization
Avera Health
 
Employer identification number
46-0422673
Part I
General Information on Grants and Assistance
1
Does the organization maintain records to substantiate the amount of the grants or assistance, the grantees' eligibility for the grants or assistance, and
the selection criteria used to award the grants or assistance? ........................
2
Describe in Part IV the organization's procedures for monitoring the use of grant funds in the United States.
Part II
Grants and Other Assistance to Domestic Organizations and Domestic Governments. Complete if the organization answered "Yes" on Form 990, Part IV, line 21, for any recipient
that received more than $5,000. Part II can be duplicated if additional space is needed.
(a) Name and address of organization
or government		 (b) EIN (c) IRC section
(if applicable)		 (d) Amount of cash grant (e) Amount of non-cash
assistance		 (f) Method of valuation
(book, FMV, appraisal,
other)		 (g) Description of
noncash assistance		 (h) Purpose of grant
or assistance
(1) Abbott House Foundation
PO Box 700
Mitchell,SD573010700 		46-0379896 501c3 42,500 0     Donation
(2) Aberdeen Catholic School Sys Inc
1400 N Dakota St
Aberdeen,SD57401 		46-0336005 501c3 11,700 0     Scholarship
(3) Aberdeen Christian School
1500 Hwy 281 N
Aberdeen,SD57401 		91-1806433 501c3 8,000 0     Donation
(4) Aberdeen Development Corporation
506 S Main St Ste 2
Aberdeen,SD57401 		46-6011831 501c6 10,000 0     Community Development
(5) City of Aberdeen
123 S Lincoln St
Aberdeen,SD574014215 		46-6000010 City of Aberdeen 25,000 0     Donation
(6) Aberdeen Family YMCA
5 S State St
Aberdeen,SD57401 		46-0255779 501c3 25,500 0     Donation
(7) Aberdeen Ride Line
205 N 4th St
Aberdeen,SD57401 		46-6000010 501c3 20,000 0     Donation
(8) Active Generations
2300 W 46th St
Sioux Falls,SD57105 		46-0305500 501c3 12,500 0     Donation
(9) ALS Assoc MN ND SD Chapter
1919 University Ave West Ste 175
St Paul,MN55104 		41-1756085 501c3 7,500 0     Donation
(10) Alzheimers Association South Dakota
4304 S Technology Dr
Sioux Falls,SD57106 		32-0151779 501c3 10,000 0     Donation
(11) American Cancer Society
250 Williams St Nw Ste 400
Atlanta,GA303031002 		13-1788491 501c3 15,000 0     Donation
(12) American Red Cross
431 18th St NW
Washington,DC20006 		53-0196605 501c3 10,000 0     Donation
(13) The Banquet
900 E 8th St
Sioux Falls,SD57103 		46-0387495 501c3 10,945 0     Donation
(14) Sioux Falls Catholic School Corporation
3100 W 41st St
Sioux Falls,SD57105 		46-0413591 501c3 850,000 0     Donation
(15) Boy Scouts of America Sioux Council
801 N West Ave
Sioux Falls,SD57104 		46-0224599 501c3 6,000 0     Donation
(16) Boys & Girls Club of Aberdeen Area
1111 SE 1st Ave
Aberdeen,SD57401 		23-7062273 501c3 9,000 0     Donation
(17) Boys & Girls Club of Capital Area
2001 Eastgate Ave
Pierre,SD57501 		46-0305571 501c3 10,000 0     Donation
(18) Boys & Girls Clubs of Sioux Empire
100 S Spring Ave Ste 280
Sioux Falls,SD57104 		46-0399482 501c3 15,000 0     Donation
(19) Brookings School District 5-1
2130 8th St S
Brookings,SD57006 		46-6000834 School District 41,700 0     Donation
(20) Call To Freedom Inc
1915 E 8th St Ste 100
Sioux Falls,SD57103 		47-5469817 501c3 27,000 0     Donation
(21) Capital Area United Way
PO Box 1111
Pierre,SD575011111 		46-0403398 501c3 5,740 0     Donation
(22) Career & Technical Education Academy
201 E 38th St
Sioux Falls,SD57105 		46-6002586 School District 10,000 0     Donation
(23) Catholic Chancery Office
523 N Duluth Ave
Sioux Falls,SD571042714 		46-6000424 501c3 110,000 0     Donation
(24) Central Lyon Community School
1010 S Greene St
Rock Rapids,IA51246 		42-6037624 School District 15,000 0     Donation
(25) Childrens Home Society
801 N Sycamore Ave
Sioux Falls,SD57110 		46-0224542 501c3 12,000 0     Donation
(26) City of Yankton
Box 176
Yankton,SD57078 		46-6000567 City of Yankton 170,586 0     Donation
(27) Compass Center
1704 S Cleveland Ave Ste 3
Sioux Falls,SD57103 		46-0350199 501c3 10,000 0     Donation
(28) Dakota Counseling institute
910 W Havens Ave
Mitchell,SD573013831 		46-0308930 501c3 50,000 0     Donation
(29) Dakota Resources
25795 475th Ave Ste 1
Renner,SD57055 		46-0442430 501c3 25,000 0     Donation
(30) Dakota Wesleyan University
1200 W University Ave
Mitchell,SD57301 		46-0224589 501c3 6,000 0     Scholarship
(31) Dakotabilities Inc
1116 S 4th Ave
Sioux Falls,SD57105 		46-0306216 501c3 20,000 0     Donation
(32) Delta Dental of SD Foundation
804 N Euclid Ste 101
Pierre,SD57501 		91-1776857 501c3 24,000 0     Donation
(33) Downtown Sioux Falls Inc
315 N Phillips Ave Ste 200
Sioux Falls,SD57104 		36-3627217 501c4 10,000 0     Community Development
(34) EmBe
300 W 11th St
Sioux Falls,SD571046306 		46-0234998 501c3 45,000 0     Donation
(35) Emily's Hope Inc
221 S Phillips Ave Ste 203
Sioux Falls,SD57104 		83-3324332 501c3 10,000 0     Donation
(36) Face It Together Inc
5020 S Tennis Ln Ste 4
Sioux Falls,SD57108 		27-2501220 501c3 15,000 0     Donation
(37) Feeding South Dakota
4701 N Westport Ave
Sioux Falls,SD571070123 		36-3293534 501c3 63,000 0     Donation
(38) Fellowship of Christian Athletes
1601 E 69th St Ste 301
Sioux Falls,SD57108 		44-0610626 501c3 16,000 0     Donation
(39) Flandreau School District 50-3
600 W Community Dr
Flandreau,SD57028 		46-6002593 School District 15,000 0     Donation
(40) Forward Sioux Falls
200 N Phillips Ave Ste 200
Sioux Falls,SD571046058 		46-0396647   730,713 0     Community Development
(41) Furniture Mission of South Dakota
209 N Nesmith Ave
Sioux Falls,SD57103 		81-0584500 501c3 17,500 0     Donation
(42) Girl Scouts-Dakota Horizons
1101 S Marion Rd
Sioux Falls,SD571063466 		46-0250744 501c3 6,000 0     Donation
(43) GL Management LLC
3800 W 53rd St
Sioux Falls,SD57106 		46-3797566   32,000 0     Community Development
(44) Governor's Office of Economic Development
711 E Well Ave
Pierre,SD57501 		46-6000364 State of SD 51,500 0     Community Development
(45) Greater Sioux Falls Chamber of Commerce
200 N Phillips Ave Ste 200
Sioux Falls,SD571046058 		46-0189300 501c6 17,750 0     Community Development
(46) Ground Works
102 N Krohns Pl Ste 113
Sioux Falls,SD57103 		47-5498537 501c3 8,000 0     Donation
(47) Helpline Center Inc
3817 S Elmwood Ave
Sioux Falls,SD57105 		23-7424387 501c3 54,500 0     Donation
(48) Junior Achievement of South Dakota
300 S Phillips Ave Ste L102
Sioux Falls,SD57104 		46-0306352 501c3 25,800 0     Donation
(49) Kids' Chance of South Dakota
300 S Main Ave
Sioux Falls,SD571046367 		47-4439997 501c3 8,000 0     Scholarship
(50) Leukemia & Lymphoma Society Inc
3 International Dr Ste
Rye Brook,NY10573 		13-5644916 501c3 15,000 0     Donation
(51) Friends of Levitt Shell Sioux Falls
400 N Main Ave Suite 202
Sioux Falls,SD57104 		61-1699910 501c3 30,000 0     Donation
(52) LIFE Runners
909 N Adams St 460651
Papillion,NE68046 		61-1672563 501c3 12,500 0     Donation
(53) LifeScape Foundation
2501 W 26th St
Sioux Falls,SD57105 		46-0353254 501c3 15,000 0     Donation
(54) Lost & Found
5015 S Crossing Pl 110
Sioux Falls,SD57108 		45-4306370 501c3 10,000 0     Donation
(55) Lutheran Social Services of South Dakota
705 E 41St St Ste 200
Sioux Falls,SD571056048 		46-0224731 501c3 10,000 0     Donation
(56) Make-A-Wish Foundation of SD
1400 W 17th St
Sioux Falls,SD57104 		46-0375953 501c3 12,500 0     Donation
(57) Marshall Area YMCA
200 S A St
Marshall,MN56258 		41-1984589 501c3 8,430 0     Donation
(58) Marshall Community Foundation
PO Box 11
Marshall,MN56258 		41-1555592 501c3 50,000 0     Donation
(59) McCrossan Boys Ranch
47135 260th St
Sioux Falls,SD571076428 		46-0311913 501c3 11,000 0     Donation
(60) Mitchell Area Development Corporation
601 N Main St
Mitchell,SD57301 		46-0394983 501c3 192,155 0     Donation
(61) Mitchell Area Safehouse Inc
1809 N Wisconsin St
Mitchell,SD57301 		46-0389086 501c3 70,000 0     Donation
(62) Mitchell School District 17-2
821 N Capital St
Mitchell,SD57301 		46-6001338 School District 9,700 0     Donation
(63) Mitchell Technical Institute Foundation
1800 E Spruce St
Mitchell,SD57301 		46-0452950 501c3 68,000 0     Donation
(64) Mitchell United Way
417 N Main St Ste 103
Mitchell,SD573010729 		46-1250302 501c3 8,036 0     Donation
(65) Mount Marty University
1105 W 8th St
Yankton,SD57078 		46-0283336 501c3 92,000 0     Scholarship
(66) NAMI of South Dakota
1601 E 69th St Ste 210
Sioux Falls,SD57108 		36-3593027 501c3 32,000 0     Donation
(67) National Kidney Foundation
30 E 33rd St Ste 100
New York,NY10016 		13-1673104 501c3 15,500 0     Donation
(68) National Multiple Sclerosis Society
733 Third Ave Flr 3
New York,NY10017 		13-5661935 501c3 12,000 0     Donation
(69) Northern State University Foundation
620 15th Ave SE
Aberdeen,SD57401 		23-7002314 501c3 1,400,000 0     Donation
(70) Pathways Shelter for the Homeless
412 E 4th St
Yankton,SD57078 		47-3974624 501c3 26,000 0     Donation
(71) Pierre Area Referral Service
110 W Missouri Ave
Pierre,SD57501 		46-0317107 501c3 20,000 0     Donation
(72) Presentation Sisters
1500 N 2nd St
Aberdeen,SD57401 		46-0253283 501c3 6,775 0     Donation
(73) Pride In The Tiger Foundation
400 Tiger Dr
Marshall,MN56258 		41-1948007 501c3 30,000 0     Donation
(74) Project CAR
2425 S Western Ave
Sioux Falls,SD57105 		46-0358227 501c3 15,000 0     Donation
(75) River Cities Public Transit
1600 E Dakota Ave
Pierre,SD57501 		46-0449059 501c3 25,000 0     Donation
(76) River City Domestic Violence Center
PO Box 626
Yankton,SD57078 		43-1992651 501c3 60,000 0     Donation
(77) Ronald McDonald House Charities
825 S Lake Ave
Sioux Falls,SD57104 		46-0371152 501c3 30,000 0     Donation
(78) Safe Harbor
PO Box 41
Aberdeen,SD57401 		46-0344310 501c3 10,000 0     Donation
(79) Sculpture Walk Inc
300 S Phillips Ave Ste 104
Sioux Falls,SD571046323 		20-8535871 501c3 21,500 0     Donation
(80) SD Youth Foundation Inc
1310 Main Ave S Ste 109
Brookings,SD57006 		47-4832848 501c3 10,000 0     Donation
(81) SDSU Foundation
PO Box 525
Brookings,SD57006 		46-0273801 501c3 25,000 0     Donation
(82) Sioux Empire Baseball Assoc Inc
1321 N Cleveland Ave
Sioux Falls,SD571036111 		41-1903475 501c3 24,000 0     Donation
(83) Sioux Empire Fastpitch Softball Association
605 S Watson Ave Ste 100
Sioux Falls,SD57108 		23-7223489 501c3 8,000 0     Donation
(84) Sioux Empire United Way
1000 N West Ave 120
Sioux Falls,SD571041332 		46-0233701 501c3 113,581 0     Donation
(85) Sioux Falls Area CASA Program
100 S Spring Ave Ste 140
Sioux Falls,SD57104 		46-0430647 501c3 10,000 0     Donation
(86) YMCA of Sioux Falls
220 S Minnesota
Sioux Falls,SD57104 		46-0225021 501c3 10,000 0     Donation
(87) Sioux Falls School District
201 E 38th St
Sioux Falls,SD57105 		46-6002586 School District 110,100 0     Donation
(88) Sioux Falls Public Schools Education Foundation
PO Box 560
Sioux Falls,SD57101 		26-3537657 501c3 14,000 0     Donation
(89) SME Inc
PO Box 90310
Sioux Falls,SD571090310 		46-6012934 501c6 6,200 0     Donation
(90) South Dakota Agricultural and Rural
Box 2170 Animal Science Ctr 132
Brookings,SD57007 		36-4293293 501c3 10,000 0     Donation
(91) South Dakota Chanmber of Commerce & Industry
222 E Capital Ave Ste 17
Pierre,SD575012564 		46-0141180 501c6 7,500 0     Community Development
(92) South Dakota State Medical Assoc
2600 W 49th St
Sioux Falls,SD57105 		46-0213945 501c6 21,000 0     Donation
(93) South Dakota State University
Multiple Locations
Brookings,SD57006 		46-6000364 State of SD 165,000 0     Donation
(94) South Dakota Symphony
301 S Main Ave 4th Flr
Sioux Falls,SD57104 		46-6017026 501c3 40,000 0     Donation
(95) Southeast Technical College
2320 N Career Ave
Sioux Falls,SD571071302 		46-0214496 State of SD 155,029 0     Donation
(96) Southwest Minnesota State University
1501 State St
Marshall,MN56258 		41-1687554 State of MN 60,000 0     Scholarship
(97) Special Olympics South Dakota
800 E I90 Ln
Sioux Falls,SD57104 		46-0359776 501c3 11,000 0     Donation
(98) Teddy Bear Den
500 S Main Ave
Sioux Falls,SD57104 		31-1802800 501c3 15,000 0     Donation
(99) United Way of NE SD Foundation
PO Box 1065
Aberdeen,SD57401 		42-1568636 501c3 17,670 0     Donation
(100) United Way of Southwest Minnesota
PO Box 41
Marshall,MN562580041 		41-6023143 501c3 5,740 0     Donation
(101) United Way & Volunteer Services of Greater Yankton
610 W 3rd St Suite 11
Yankton,SD57078 		46-0252854 501c3 12,607 0     Donation
(102) University of MN Foundation Medical School Duluth Campus
1035 University Dr
Duluth,MN55812 		41-6042488 501c3 24,000 0     Scholarship
(103) University of Sioux Falls
1101 W 22nd St
Sioux Falls,SD57105 		46-0224600 501c3 330,000 0     Donation
(104) University of South Dakota
414 E Clark St
Vermillion,SD57069 		46-6000364 State of SD 473,000 0     Scholarship
(105) USD Foundation
1100 N Dakota
Vermillion,SD57069 		46-6018891 501c3 20,000 0     Scholarship
(106) USD Gear Center
414 E Clark St
Vermillion,SD57069 		46-6000364 State of SD 6,300 0     Donation
(107) Veterans Community Project
8900 Troost Ave
Kansas City,MO64131 		47-4960735 501c3 30,000 0     Donation
(108) Volunteers of America Dakotas
PO Box 89306
Sioux Falls,SD57109 		23-7353508 501c3 41,000 0     Donation
(109) Washington Pavilion Management Inc
PO Box 984
Sioux Falls,SD571010984 		46-0435791 501c3 80,286 0     Donation
(110) Yankton Thrive Inc
803 E 4th St
Yankton,SD57078 		46-0348636 501c3 60,000 0     Donation
(111) Yankton Parks & Rec
PO Box 176
Yankton,SD57078 		46-6000567 City of Yankon 10,000 0     Donation
(112) Yankton School District 63-3
2410 W City Limits Rd
Yankton,SD57078 		46-6003280 School District 10,000 0     Donation
(113) University of South Dakota Research Park
4800 N Career Ave Suite 100
Sioux Falls,SD57107 		46-2693612 501c3 50,580 0     Donation
(114) South Dakota Community Foundation
Po Box 296
Pierre,SD57501 		46-0398115 501c3 200,493 0     Donation
(115) Teammates Mentoring Program
121 S 13th St
Lincoln,NE68508 		47-0840990 501c3 93,352 0     Donation
(116) University of South Dakota - South Dakota HOSA Future Health Professionals
4801 N Career Ave
Sioux Falls,SD571071329 		46-6000364 State of SD 30,000 0     Donation
2
Enter total number of section 501(c)(3) and government organizations listed in the line 1 table ................. Bullet Image
118
3
Enter total number of other organizations listed in the line 1 table ........................ . Bullet Image
8
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50055P
Schedule I (Form 990) 2023

Schedule I (Form 990) 2023
Page 2
Part III
Grants and Other Assistance to Domestic Individuals. Complete if the organization answered "Yes" on Form 990, Part IV, line 22.
Part III can be duplicated if additional space is needed.
(a) Type of grant or assistance (b) Number of
recipients		 (c) Amount of
cash grant		 (d) Amount of
noncash assistance		 (e) Method of valuation (book,
FMV, appraisal, other)		 (f) Description of noncash assistance
(1) Medical assistance to employees 23 42,242      
(2) Medical educational scholarships 10 10,000      
(3) Pastoral educational scholarships 17 44,500      
(3)
(4)
(5)
(6)
(7)
Part IV
Supplemental Information. Provide the information required in Part I, line 2; Part III, column (b); and any other additional information.
Return Reference Explanation
Part I, Line 2: The Organization makes grants to other organizations exempt under 501(c)(3) to ensure the funds will be used for charitable purposes. During the year ending June 30, 2024, 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.
Schedule I (Form 990) 2023



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Schedule J
(Form 990)
Department of the Treasury
Internal Revenue Service
Compensation Information
For certain Officers, Directors, Trustees, Key Employees, and Highest
Compensated Employees
medium right arrow graphic Complete if the organization answered "Yes" on Form 990, Part IV, line 23.
medium right arrow graphic Attach to Form 990.
medium right arrow graphic Go to www.irs.gov/Form990 for instructions and the latest information.
OMB No. 1545-0047
2023
Open to Public Inspection
Name of the organization
Avera Health
 
Employer identification number

46-0422673
Part I
Questions Regarding Compensation
Yes
No
1a
Check the appropiate box(es) if the organization provided any of the following to or for a person listed on Form
990, Part VII, Section A, line 1a. Complete Part III to provide any relevant information regarding these items.
b
If any of the boxes on Line 1a are checked, did the organization follow a written policy regarding payment or reimbursement or provision of all of the expenses described above? If "No," complete Part III to explain .....
1b
 
 
2
Did the organization require substantiation prior to reimbursing or allowing expenses incurred by all
directors, trustees, officers, including the CEO/Executive Director, regarding the items checked on Line 1a? ....
2
 
 
3
Indicate which, if any, of the following the filing organization used to establish the compensation of the
organization's CEO/Executive Director. Check all that apply. Do not check any boxes for methods
used by a related organization to establish compensation of the CEO/Executive Director, but explain in Part III.
4
During the year, did any person listed on Form 990, Part VII, Section A, line 1a, with respect to the filing organization or a related organization:
a
Receive a severance payment or change-of-control payment? .............
4a
Yes
 
b
Participate in, or receive payment from, a supplemental nonqualified retirement plan? .........
4b
 
No
c
Participate in, or receive payment from, an equity-based compensation arrangement? .........
4c
 
No
If "Yes" to any of lines 4a-c, list the persons and provide the applicable amounts for each item in Part III.
Only 501(c)(3), 501(c)(4), and 501(c)(29) organizations must complete lines 5-9.
5
For persons listed on Form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the revenues of:
a
The organization? ....................
5a
 
No
b
Any related organization? .......................
5b
 
No
If "Yes," on line 5a or 5b, describe in Part III.
6
For persons listed on Form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the net earnings of:
a
The organization? ..................
6a
 
No
b
Any related organization? ......................
6b
 
No
If "Yes," on line 6a or 6b, describe in Part III.
7
For persons listed on Form 990, Part VII, Section A, line 1a, did the organization provide any nonfixed
payments not described in lines 5 and 6? If "Yes," describe in Part III ............
7
Yes
 
8
Were any amounts reported on Form 990, Part VII, paid or accured pursuant to a contract that was
subject to the initial contract exception described in Regulations section 53.4958-4(a)(3)? If "Yes," describe
in Part III ..........................
8
 
No
9
If "Yes" on line 8, did the organization also follow the rebuttable presumption procedure described in Regulations section 53.4958-6(c)? .........................
9
 
 
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50053T
Schedule J (Form 990) 2023

Schedule J (Form 990) 2023
Page 2
Part II
Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees. Use duplicate copies if additional space is needed.
For each individual whose compensation must be reported on Schedule J, report compensation from the organization on row (i) and from related organizations, described in the
instructions, on row (ii). Do not list any individuals that are not listed on Form 990, Part VII.
Note. The sum of columns (B)(i)-(iii) for each listed individual must equal the total amount of Form 990, Part VII, Section A, line 1a, applicable column (D) and (E) amounts for that individual.
(A) Name and Title (B) Breakdown of W-2, 1099-MISC compensation, and/or 1099-NEC (C) Retirement and other deferred compensation (D) Nontaxable
benefits		 (E) Total of columns
(B)(i)-(D) 		(F) Compensation in column (B) reported as deferred on prior Form 990
(i) Base
compensation 		(ii) Bonus & incentive
compensation 		(iii) Other reportable compensation
1Bob Sutton
President/CEO (End 08/2023) 		(i)

(ii)		 2,068,183
-------------
0 		0
-------------
0 		12,280
-------------
0 		16,500
-------------
0 		43,933
-------------
0 		2,140,896
-------------
0 		0
-------------
0
2Thomas Clark Former
Chief Strategy & Growth Officer 		(i)

(ii)		 6,334
-------------
0 		0
-------------
0 		1,660,062
-------------
0 		16,500
-------------
0 		8,750
-------------
0 		1,691,646
-------------
0 		0
-------------
0
3David Flicek
Chief Operating Officer 		(i)

(ii)		 1,327,499
-------------
0 		700
-------------
0 		43,392
-------------
0 		16,500
-------------
0 		28,597
-------------
0 		1,416,688
-------------
0 		0
-------------
0
4Julie Lautt
CFO, Treasurer 		(i)

(ii)		 1,197,590
-------------
0 		480
-------------
0 		5,605
-------------
0 		16,500
-------------
0 		2,901
-------------
0 		1,223,076
-------------
0 		0
-------------
0
5Kevin Post
Chief Medical Officer 		(i)

(ii)		 797,551
-------------
0 		270
-------------
0 		2,703
-------------
0 		16,500
-------------
0 		43,952
-------------
0 		860,976
-------------
0 		0
-------------
0
6Richard Korman
Chief Legal Officer, Secretary 		(i)

(ii)		 798,056
-------------
0 		0
-------------
0 		10,519
-------------
0 		16,500
-------------
0 		33,877
-------------
0 		858,952
-------------
0 		0
-------------
0
7Casey Swenson
Radiology 		(i)

(ii)		 596,763
-------------
0 		105,739
-------------
0 		31,253
-------------
0 		16,500
-------------
0 		41,133
-------------
0 		791,388
-------------
0 		0
-------------
0
8Dr Luis Rojas-Espaillat
Chair, Gynecologic Oncology 		(i)

(ii)		 0
-------------
661,963 		0
-------------
24,000 		0
-------------
11,292 		0
-------------
24,960 		0
-------------
28,561 		0
-------------
750,776 		0
-------------
0
9Dr Ronald Place
President/CEO, McKennan 		(i)

(ii)		 676,736
-------------
0 		30,000
-------------
0 		20,122
-------------
0 		16,500
-------------
0 		530
-------------
0 		743,888
-------------
0 		0
-------------
0
10Bruk Kammerman
Sr. VP - Chief Information 		(i)

(ii)		 693,883
-------------
0 		0
-------------
0 		2,653
-------------
0 		16,500
-------------
0 		1,439
-------------
0 		714,475
-------------
0 		0
-------------
0
11Shandon Hatch
Radiology 		(i)

(ii)		 561,502
-------------
0 		56,608
-------------
0 		38,469
-------------
0 		16,500
-------------
0 		40,902
-------------
0 		713,981
-------------
0 		0
-------------
0
12Doug Ekeren
President/CEO, Sacred Heart 		(i)

(ii)		 641,698
-------------
0 		900
-------------
0 		10,020
-------------
0 		16,500
-------------
0 		33,877
-------------
0 		702,995
-------------
0 		0
-------------
0
13Kimberly Jensen
Chief Human Resources Officer 		(i)

(ii)		 636,041
-------------
0 		650
-------------
0 		14,091
-------------
0 		16,500
-------------
0 		27,047
-------------
0 		694,329
-------------
0 		0
-------------
0
14David Erickson
Former Chief Medical Officer 		(i)

(ii)		 17,614
-------------
0 		0
-------------
0 		612,906
-------------
0 		16,500
-------------
0 		0
-------------
0 		647,020
-------------
0 		0
-------------
0
15Daniel Bjerknes
President/CEO, St. Luke's 		(i)

(ii)		 498,188
-------------
0 		0
-------------
0 		4,896
-------------
0 		16,500
-------------
0 		33,971
-------------
0 		553,555
-------------
0 		0
-------------
0
16Dr Katherine Wang
Board Member, Neonatology 		(i)

(ii)		 0
-------------
414,028 		0
-------------
91,886 		0
-------------
1,264 		0
-------------
16,500 		0
-------------
935 		0
-------------
524,613 		0
-------------
0
17Dr Hillary Rockwell
President/CEO, Queen of Peace 		(i)

(ii)		 237,154
-------------
213,545 		7,500
-------------
7,500 		660
-------------
630 		5,507
-------------
10,993 		20,449
-------------
20,454 		271,270
-------------
253,122 		0
-------------
0
18Dr Jason Wickersham
Board Member, Family Medicine/OBGYN 		(i)

(ii)		 0
-------------
399,955 		0
-------------
61,932 		0
-------------
1,214 		0
-------------
16,500 		0
-------------
33,660 		0
-------------
513,261 		0
-------------
0
19Debbie Streier
President/CEO, Marshall 		(i)

(ii)		 481,234
-------------
0 		440
-------------
0 		7,726
-------------
0 		16,500
-------------
0 		935
-------------
0 		506,835
-------------
0 		0
-------------
0
20James Dover
President/CEO (Eff 10/2023) 		(i)

(ii)		 388,194
-------------
0 		0
-------------
0 		8,199
-------------
0 		0
-------------
0 		3,389
-------------
0 		399,782
-------------
0 		0
-------------
0
21Shantel Krebs
President/CEO, St. Mary's 		(i)

(ii)		 79,808
-------------
173,373 		0
-------------
4,000 		3,423
-------------
9,050 		8,869
-------------
8,869 		259
-------------
259 		92,359
-------------
195,551 		0
-------------
0
Schedule J (Form 990) 2023

Schedule J (Form 990) 2023
Page 3
Part III
Supplemental Information
Provide the information, explanation, or descriptions required for Part I, lines 1a, 1b, 3, 4a, 4b, 4c, 5a, 5b, 6a, 6b, 7, and 8, and for Part II. Also complete this part for any additional information.
Return Reference Explanation
Part I, Line 4a Thomas Clark received severance pay of $1,660,062. David Erickson received severance pay of $612,906.
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 J (Form 990) 2023

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Schedule K
(Form 990)
Department of the Treasury
Internal Revenue Service
Supplemental Information on Tax-Exempt Bonds
Complete if the organization answered "Yes" to Form 990, Part Ⅵ, line 24a. Provide descriptions,
explanations, and any additional information in Part Ⅵ.
Attach to Form 990.
Go to www.irs.gov/Form990 for instructions and the latest information.
OMB No. 1545-0047
2023
Open to Public
Inspection
Name of the organization
Avera Health
 
Employer identification number
46-0422673
Part Ⅰ
Bond Issues
(a) Issuer name (b) Issuer EIN (c) CUSIP # (d) Date issued (e) Issue price (f) Description of purpose (g) Defeased (h) On
behalf of
issuer		 (i) Pool
financing
Yes No Yes No Yes No
A South Dakota Health and Educational Facilities Authority
  		46-0315509 83755VUS1 05-01-2012 206,383,927 Series 2012B refunded 2002 and 2008A bonds issued 4/11/02 and 6/18/08   X   X   X
B South Dakota Health and Educational Facilities Authority
  		46-0315509 83755VG99 10-11-2017 242,848,916 Series 2017 refunded bond issued 6/18/08;const/equip healthcare facilities   X   X   X
C South Dakota Health and Educational Facilities Authority
  		46-0315509 83755VU44 04-24-2024 114,418,553 See Supplemental Detail   X   X   X
D South Dakota Health and Educational Facilities Authority
  		46-0315509 83755VU44 04-24-2024 251,862,322 Construction/equipment healthcare facilities   X   X   X
Part Ⅱ
Proceeds
A B C D
1 Amount of bonds retired .................. 108,668,927 23,293,916    
2 Amount of bonds legally defeased ..............        
3 Total proceeds of issue .................. 206,383,927 242,848,916 114,418,553 251,862,322
4 Gross proceeds in reserve funds .............        
5 Capitalized interest from proceeds .............        
6 Proceeds in refunding escrows ...............        
7 Issuance costs from proceeds ............... 1,032,422 1,786,422 742,310 1,633,842
8 Credit enhancement from proceeds .............        
9 Working capital expenditures from proceeds .............        
10 Capital expenditures from proceeds ............. 38,100,000 190,000,000   42,346,205
11 Other spent proceeds ............. 167,251,505 51,062,494 113,676,243  
12 Other unspent proceeds .............       207,882,275
13 Year of substantial completion ............. 2013
Yes No Yes No Yes No Yes No
14 Were the bonds issued as part of a current refunding issue of tax-exempt
bonds (or, if issued prior to 2020, a current refunding issue)? ........ 		X     X X     X
15 Were the bonds issued as part of an advance refunding issue of taxable
bonds (or, if issued prior to 2020, an advance refunding issue)? ........ 		  X X   X     X
16 Has the final allocation of proceeds been made? .......... X   X   X     X
17 Does the organization maintain adequate books and records to support the final allocation of proceeds? .................. X   X   X   X  
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50193E
Schedule K (Form 990) 2023

Schedule K (Form 990) 2023
Page 2
Part Ⅲ
Private Business Use
A B C D
Yes No Yes No Yes No Yes No
1 Was the organization a partner in a partnership, or a member of an LLC, which owned property financed by tax-exempt bonds? .............   X   X   X   X
2 Are there any lease arrangements that may result in private business use of bond-financed property? ............... X     X   X   X
3a Are there any management or service contracts that may result in private business use of bond-financed property? ............. X     X   X   X
b If "Yes" to line 3a, does the organization routinely engage bond counsel or other outside counsel to review any management or service contracts relating to the financed property?   X            
c Are there any research agreements that may result in private business use of bond-financed property? .............   X   X   X   X
d If "Yes" to line 3c, does the organization routinely engage bond counsel or other outside counsel to review any research agreements relating to the financed property?                
4 Enter the percentage of financed property used in a private business use by entities other than a section 501(c)(3) organization or a state or local government .... 0 % 0 % 0 % 0 %
5 Enter the percentage of financed property used in a private business use as a result of unrelated trade or business activity carried on by your organization, another section 501(c)(3) organization, or a state or local government ......... 0 % 0 % 0 % 0 %
6 Total of lines 4 and 5 ............. 0 % 0 % 0 % 0 %
7 Does the bond issue meet the private security or payment test? ...   X   X   X   X
8a Has there been a sale or disposition of any of the bond-financed property to a nongovernmental person other than a 501(c)(3) organization since the bonds were issued?.............   X   X   X   X
b If "Yes" to line 8a, enter the percentage of bond-financed property sold or disposed of. ..        
c If "Yes" to line 8a, was any remedial action taken pursuant to Regulations sections 1.141-12 and 1.145-2? .............                
9 Has the organization established written procedures to ensure that all nonqualified bonds of the issue are remediated in accordance with the requirements under
Regulations sections 1.141-12 and 1.145-2? ........ 		X   X   X   X  
Part Ⅳ
Arbitrage
A B C D
Yes No Yes No Yes No Yes No
1 Has the issuer filed Form 8038-T, Arbitrage Rebate, Yield Reduction and Penalty in Lieu of Arbitrage Rebate? ...   X   X   X   X
2 If "No" to line 1, did the following apply? ....
a Rebate not due yet? .......   X   X   X   X
b Exception to rebate? ........ X   X     X   X
c No rebate due? .........   X   X   X   X
If "Yes" to line 2c, provide in Part Ⅵ the date the rebate
computation was performed ......
3 Is the bond issue a variable rate issue? ..... X     X   X   X
Schedule K (Form 990) 2023

Schedule K (Form 990) 2023
Page 3
Part Ⅳ
Arbitrage (Continued)
A B C D
Yes No Yes No Yes No Yes No
4a Has the organization or the governmental issuer entered into a qualified hedge with respect to the bond issue?   X   X   X   X
b Name of provider ..........  
  		 
  		 
  		 
 
c Term of hedge .........        
d Was the hedge superintegrated? ......                
e Was the hedge terminated? ........                
5a Were gross proceeds invested in a guaranteed investment contract (GIC)?   X   X   X   X
b Name of provider ..........  
  		 
  		 
  		 
 
c Term of GIC .........        
d Was the regulatory safe harbor for establishing the fair market value of the GIC satisfied? ........                
6 Were any gross proceeds invested beyond an available temporary period?   X   X   X   X
7 Has the organization established written procedures to monitor the requirements of section 148? ... X   X   X   X  
Part Ⅴ
Procedures To Undertake Corrective Action
A B C D
Yes No Yes No Yes No Yes No
Has the organization established written procedures to ensure that violations of federal tax requirements are timely identified and corrected through the voluntary closing agreement program if self-remediation is not available under applicable regulations? X   X   X   X  
Part Ⅵ
Supplemental Information. Provide additional information for responses to questions on Schedule K. (See instructions).
Return Reference Explanation
Part I, Line (f) Description of purpose, Bond C: Refund Series 2014 Bonds issued 6/26/2014, Series 2019A Bonds issued 11/13/2019, and2017 taxable loan obtained 6/28/2017.
Schedule K (Form 990) 2023

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Schedule L
(Form 990)
Department of the Treasury
Internal Revenue Service
Transactions with Interested Persons
Complete if the organization answered "Yes" on Form 990, Part IV, lines 25a, 25b, 26, 27, 28a, 28b, or 28c, or Form 990-EZ, Part V, line 38a or 40b.
Attach to Form 990 or Form 990-EZ.
Go to www.irs.gov/Form990 for instructions and the latest information.
OMB No. 1545-0047
2023
Open to Public Inspection
Name of the organization
Avera Health
 
Employer identification number

46-0422673
Part I
Excess Benefit Transactions (section 501(c)(3), section 501(c)(4), and section 501(c)(29) organizations only).
Complete if the organization answered "Yes" on Form 990, Part IV, line 25a or 25b, or Form 990-EZ, Part V, line 40b.
1(a) Name of disqualified person (b) Relationship between disqualified person and organization (c) Description of transaction (d) Corrected?
Yes No
2
Enter the amount of tax incurred by the organization managers or disqualified persons during the year under section 4958. ........................... $
 
3
Enter the amount of tax, if any, on line 2, above, reimbursed by the organization ........ $
 

Part II
Loans to and/or From Interested Persons.
Complete if the organization answered "Yes" on Form 990-EZ, Part V, line 38a, or Form 990, Part IV, line 26; or if the organization reported an amount on Form 990, Part X, line 5, 6, or 22
(a) Name of interested person (b) Relationship with organization (c) Purpose of loan (d) Loan to or from the organization? (e) Original principal amount (f) Balance due (g) In default? (h) Approved by board or committee? (i) Written agreement?
To From Yes No Yes No Yes No
(1) Debbie Streier Key Employee Student Loan   X 13,187 1,272   No Yes   Yes  
(2) Debbie Streier Key Employee Retention Loan   X 10,000 1,016   No Yes   Yes  
Total ............... $ 2,288
Part III
Grants or Assistance Benefiting Interested Persons.
Complete if the organization answered "Yes" on Form 990, Part IV, line 27.
(a) Name of interested person (b) Relationship between interested person and the organization (c) Amount of assistance (d) Type of assistance (e) Purpose of assistance
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.
Cat. No. 50056A
Schedule L (Form 990) 2023
Schedule L (Form 990) 2023
Page 2
Part IV
Business Transactions Involving Interested Persons.
Complete if the organization answered "Yes" on Form 990, Part IV, line 28a, 28b, or 28c.
(a) Name of interested person (b) Relationship between interested person and the organization (c) Amount of transaction (d) Description of transaction (e) Sharing of organization's revenues?
Yes No
(1) Katherine Schild Family member of Key Employee, Doug Ekeren 102,824 Compensation and benefits as an employee   No
(2) Grant Flicek Family member of Key Employee, David Flicek 170,744 Compensation and benefits as an employee   No
Part V
Supplemental Information
Provide additional information for responses to questions on Schedule L (see instructions).
Return Reference Explanation
Schedule L (Form 990) 2023


Additional Data


Software ID:  
Software Version:  




SCHEDULE M
(Form 990)

Department of the Treasury
Internal Revenue Service
Noncash Contributions
Right pointing arrow large image Complete if the organizations answered "Yes" on Form 990, Part IV, lines 29 or 30.
Right pointing arrow large image Attach to Form 990.
Right pointing arrow large image Go to www.irs.gov/Form990 for the latest information.
OMB No. 1545-0047
2023
Open to Public Inspection
Name of the organization
Avera Health
 
Employer identification number

46-0422673
Part I
Types of Property
(a)
Check if applicable 		(b)
Number of contributions or items contributed 		(c)
Noncash contribution amounts reported on
Form 990, Part VIII, line 1g 		(d)
Method of determining
noncash contribution amounts
1 Art—Works of art ....        
2 Art—Historical treasures .        
3 Art—Fractional interests ..        
4 Books and publications ..      
5 Clothing and household
goods ....... 		     
6 Cars and other vehicles ..        
7 Boats and planes ....        
8 Intellectual property ...        
9 Securities—Publicly traded . X 1 62,526 Selling Price
10 Securities—Closely held stock .        
11 Securities—Partnership, LLC,
or trust interests .... 		       
12 Securities—Miscellaneous ..        
13 Qualified conservation
contribution—Historic
structures ..... 		       
14 Qualified conservation
contribution—Other ... 		       
15 Real estate—Residential .        
16 Real estate—Commercial ..        
17 Real estate—Other ...        
18 Collectibles .....        
19 Food inventory ...        
20 Drugs and medical supplies .        
21 Taxidermy ......        
22 Historical artifacts ....        
23 Scientific specimens ..        
24 Archeological artifacts ...        
25 Other Right pointing arrow large image ( Items for Patients ) X 3 23,174 Cost
26 Other Right pointing arrow large image ( Auction Items ) X 11 14,665 FMV
27 Other Right pointing arrow large image ( Lights, Light Poles, and installation ) X 1 13,000 Cost
28 Other Right pointing arrow large image ( Chairs ) X 1 3,144 FMV
29
Number of Forms 8283 received by the organization during the tax year for contributions
for which the organization completed Form 8283, Part IV, Donee Acknowledgement
29
0
Yes
No
30a
During the year, did the organization receive by contribution any property reported in Part I, lines 1 through 28, that it must hold for at least three years from the date of the initial contribution, and which isn't required to be used for exempt purposes for the entire holding period? ...................
30a
 
No
b
If "Yes," describe the arrangement in Part II.
31
Does the organization have a gift acceptance policy that requires the review of any nonstandard contributions?
31
Yes
 
32a
Does the organization hire or use third parties or related organizations to solicit, process, or sell noncash
contributions? ..........................
32a
 
No
b
If "Yes," describe in Part II.
33
If the organization didn't report an amount in column (c) for a type of property for which column (a) is checked,
describe in Part II.
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 51227J
Schedule M (Form 990) (2023)
Schedule M (Form 990) (2023)
Page 2
Part IISupplemental Information. Provide the information required by Part I, lines 30b, 32b, and 33, and whether the organization is reporting in Part I, column (b), the number of contributions, the number of items received, or a combination of both. Also complete this part for any additional information.
Return Reference Explanation
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 M (Form 990) (2023)

Additional Data


Software ID:  
Software Version:  
SCHEDULE O
(Form 990)

Department of the Treasury
Internal Revenue Service
Supplemental Information to Form 990 or 990-EZ

Complete to provide information for responses to specific questions on
Form 990 or 990-EZ or to provide any additional information.
Attach to Form 990 or 990-EZ.
 Go to www.irs.gov/Form990 for the latest information.
OMB No. 1545-0047
2023
Open to Public
Inspection
Name of the organization
Avera Health
 
Employer identification number

46-0422673
Return Reference Explanation
Form 990, Part VI, Section A, line 2 Julie Lautt, Dr. Luis Rojas-Espaillat, Dr. Katherine Wang, and Dr. Jason Wickersham have a business relationship.
Form 990, Part VI, Section A, line 6 Avera Health has two classes of members: Sponsorship Members and System Members. Sponsorship Members shall consist collectively of (i) those persons serving from time to time as the President and Council of the Presentation Sisters of the Blessed Virgin Mary of Aberdeen, South Dakota and (ii) those persons serving from time to time as the Prioress and Council of the Benedictine Convent of the Sacred Heart (Yankton, S.D.). System Members shall consist of up to nine members (i) three Presentation Sisters or their designees appointed by the Presentation Sponsorship Members; (ii) three Benedictine Sisters or their designees appointed by the Benedictine Sponsorship Members; and (iii) up to three additional members appointed by the Sponsorship Members. At no time shall the number of designees be greater than the total number of Benedictine and Presentation Sisters.
Form 990, Part VI, Section A, line 7a The System Members have the power to appoint the Board of Directors of Avera Health and to suspend or remove a Director at any time, with or without cause. They also have the power to appoint a Benedictine Sister, Presentation Sister, or a Ministerial Juridic Person to the Boards of Directors of any sponsored work or ministry of Avera Health.
Form 990, Part VI, Section A, line 7b The following powers shall be reserved to and exercised exclusively by the Sponsorship Members and none of the following actions shall be taken by Avera Health without action of the Sponsorship Members: (a) To approve the adoption, amendment or repeal of the statements of philosophy, mission, Guiding Principles and values of Avera Health; (b) To initiate the adoption, amendment or repeal of any provision of the Articles of Incorporation or Bylaws of Avera Health, and to give final approval of any such action with respect thereto; (c) To establish policies regarding the alienation of real property and precious artifacts associated with the healthcare ministry which are under the canonical stewardship of the Presentation Sisters or the Benedictine Sisters; (d) To approve any plan of merger, consolidation or dissolution of Avera Health, or the divestiture of any sponsored work or ministry associated with Avera Health; (e) To change the composition of the Sponsorship Members, including the addition of other individuals, parties or entities to be Sponsorship Members; and (f) To approve the creation of new sponsored works or ministries to be conducted by or under the authority of Avera Health. The following powers shall be reserved to and exercised exclusively by the System Members and none of the following actions shall be taken by Avera Health without action of the System Members: (a) To appoint the Board of Directors of Avera Health and to suspend or remove a Director at any time, with or without cause; (b) To appoint a Presentation Sister, a Benedictine Sister, or a Ministerial Juridic Person 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; (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 Members' approval or action; (j) To adopt policies designed to effectuate the powers reserved to the System 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. In addition, the Form 990 is made available to the Facility CEO and other Operation Finance Leaders. The public disclosure copy is made available to 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 Annually the Compensation Committee of Avera Health, which is comprised of six (6) system members appointed by the religious orders, meets with an independent consultant regarding fair market value for compensation of officers and key employees. The Compensation Committee approves all salaries based on comparable data and documents the basis for their decision in meeting minutes.
Form 990, Part VI, Section C, line 19 The Organization's governing documents, conflict of interest policy, and financial statements are not made available to the general public.
Form 990, Part 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 -25,210,550. Other changes in net assets -1,994,572. Net assets released from restriction -494,949. Adjustments to the funded status of pension plans 43,614,103. Non Operating Other -9,540,393. Reclassification of prior year donation expense 500,000. Contributions received by Avera Health Foundation not reflected in financial statements -10,596,831. Grants to organizations distributed by Avera Health Foundation not reflected in financial statements 8,669,567.
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.
Cat. No. 51056K
Schedule O (Form 990) 2023


Additional Data


Software ID:  
Software Version:  
SCHEDULE R
(Form 990)
Department of the Treasury
Internal Revenue Service
Related Organizations and Unrelated Partnerships
Complete if the organization answered "Yes" on Form 990, Part IV, line 33, 34, 35b, 36, or 37.
Attach to Form 990.
Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047
2023
Open to Public Inspection
Name of the organization
Avera Health
 
Employer identification number

46-0422673
Part I
Identification of Disregarded Entities. Complete if the organization answered "Yes" on Form 990, Part IV, line 33.
(a)
Name, address, and EIN (if applicable) of disregarded entity


(b)
Primary activity


 		(c)
Legal domicile (state
or foreign country)

 		(d)
Total income


 		(e)
End-of-year assets


 		(f)
Direct controlling
entity










Part II
Identification of Related Tax-Exempt Organizations. Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related tax-exempt organizations during the tax year.
(a)
Name, address, and EIN of related organization


(b)
Primary activity


 		(c)
Legal domicile (state
or foreign country)

 		(d)
Exempt Code section


 		(e)
Public charity status
(if section 501(c)(3))

 		(f)
Direct controlling
entity

 		(g)
Section 512(b)(13) controlled entity?
Yes No
(1)Avera McKennan
1325 S Cliff Ave PO Box 5045

Sioux Falls,SD57117
46-0224743 		Healthcare services SD 501(c)(3) Line 3 Avera Health
 
Yes
 
(2)Avera at Home
5300 S Broadband Lane

Sioux Falls,SD57108
46-0399291 		Home services SD 501(c)(3) Line 10 Avera Health
 
Yes
 
(3)Avera Health Plans Inc
3900 West Avera Drive Suite 101

Sioux Falls,SD57108
46-0451539 		Health financing & health plan admin SD 501(c)(4)   Avera Health
 
Yes
 
(4)Avera Marshall
300 S Bruce Street

Marshall,MN56258
41-0919153 		Healthcare services MN 501(c)(3) Line 3 Avera Health
 
Yes
 
(5)Avera Granite Falls
345 10th Ave

Granite Falls,MN56241
84-3156881 		Healthcare services MN 501(c)(3) Line 3 Avera Marshall
 
 
No
(6)Avera Tyler
240 Willow Street

Tyler,MN56178
41-0853163 		Healthcare services MN 501(c)(3) Line 3 Avera Marshall
 
Yes
 
(7)Avera Queen of Peace Hospital
525 North Foster

Mitchell,SD57301
46-0224604 		Healthcare services SD 501(c)(3) Line 3 Avera Health
 
Yes
 
(8)Avera St Anthony's Hospital
300 N 2nd Street

ONeill,NE68763
47-0463911 		Healthcare services NE 501(c)(3) Line 3 Avera Health
 
Yes
 
(9)Avera St Luke's
305 South State Street

Aberdeen,SD57401
46-0224598 		Healthcare services SD 501(c)(3) Line 3 Avera Health
 
Yes
 
(10)Avera St Mary's
801 East Sioux Avenue

Pierre,SD57501
46-0230199 		Healthcare services SD 501(c)(3) Line 3 Avera Health
 
Yes
 
(11)Avera Gettysburg
606 East Garfield

Gettysburg,SD57442
46-0234354 		Healthcare services SD 501(c)(3) Line 3 Avera St Mary's
 
Yes
 
(12)Avera Holy Family
826 North 8th Street

Estherville,IA51334
42-0680370 		Healthcare services IA 501(c)(3) Line 3 Avera Health
 
Yes
 
(13)Holy Family Hospital Foundation
826 North 8th Street

Estherville,IA51334
42-1317452 		Support health related services IA 501(c)(3) Line 10 Avera Holy Family
 
Yes
 
(14)Sacred Heart Health Services
501 Summit Street

Yankton,SD57078
46-0225483 		Healthcare services SD 501(c)(3) Line 3 Avera Health
 
Yes
 
(15)Lewis and Clark Health Education and Service Agency
1000 W 4th Street Suite 9

Yankton,SD57078
46-0337013 		Healthcare services SD 501(c)(3) Line 10 Avera Health
 
Yes
 
(16)St Benedict Health Center
401 West Glynn Drive

Parkston,SD57366
46-0226738 		Healthcare services SD 501(c)(3) Line 3 Avera Health
 
Yes
 
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50135Y
Schedule R (Form 990) 2023
Schedule R (Form 990) 2023
Page 2
Part III
Identification of Related Organizations Taxable as a Partnership. Complete if the organization answered "Yes" on Form 990, Part IV, line 34, because it had one or more related organizations treated as a partnership during the tax year.
(a)
Name, address, and EIN of
related organization



 		(b)
Primary activity




 		(c)
Legal
domicile
(state or foreign
country)


 		(d)
Direct controlling
entity



 		(e)
Predominant income(related, unrelated, excluded from tax under sections 512-514)

(f)
Share of total income




 		(g)
Share of end-of-year
assets



 		(h)
Disproprtionate allocations?




 		(i)
Code V-UBI
amount in box 20 of
Schedule K-1
(Form 1065)
 		(j)
General or
managing
partner?



 		(k)
Percentage
ownership
Yes No Yes No
(1) Avera Home Medical Equipment of Floyd Valley Hospital LLC

5300 S Broadband Lane
Sioux Falls,SD57108
82-0582350 		Medical services - home medical equipment SD N/A
         No     No  
(2) Avera Home Medical Equipment of Lakes Regional Healthcare LLC

5300 S Broadband Lane
Sioux Falls,SD57108
86-2949748 		Medical services - home medical equipment SD N/A
         No     No  
(3) Avera Home Medical Equipment of Sioux Center LLC

5300 S Broadband Lane
Sioux Falls,SD57108
75-3203100 		Medical services - home medical equipment SD N/A
         No     No  
(4) Avera Home Medical Equipment of Spencer Hospital LLC

5300 S Broadband Lane
Sioux Falls,SD57108
80-0619999 		Medical services - home medical equipment SD N/A
         No     No  
(5) Brookings Health System - Avera HME LLC

300 22nd Ave
Brookings,SD57006
45-3204123 		Healthcare Services SD N/A
         No     No  
(6) Caravan Health ACO 15 LLC dba Prairie Vista Care Organization

4055 Valley View Lane Ste 700
Dallas,TX75244
61-1843657 		Accountable Care Organization MO N/A
         No     No  
(7) Caravan Health ACO 41 LLC dba Prairie View Care Organization

4055 Valley View Lane Ste 700
Dallas,TX75244
82-1447782 		Accountable Care Organization MO N/A
         No     No  
(8) Heart Hospital of South Dakota LLC

4500 W 69th Street
Sioux Falls,SD57108
56-2143771 		Healthcare Services SD N/A
         No     No  
(9) Surgical Associates Endoscopy Clinic LLC

310 S Penn
Aberdeen,SD57401
46-0461429 		Surgical associates SD N/A
         No     No  
Part IV
Identification of Related Organizations Taxable as a Corporation or Trust. Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related organizations treated as a corporation or trust during the tax year.
(a)
Name, address, and EIN of
related organization
 		(b)
Primary activity
 		(c)
Legal
domicile
(state or foreign
country)
 		(d)
Direct controlling
entity
 		(e)
Type of entity
(C corp, S corp,
or trust) 		(f)
Share of total income
 		(g)
Share of end-of-year
assets
 		(h)
Percentage
ownership
 		(i)
Section 512(b)(13) controlled entity?
Yes No
(1) Accounts Management Inc

5132 S Cliff Ave Suite 101
Sioux Falls,SD57108
46-0373021 		Collection Agency SD Avera Health
  		C 4,674,347 3,287,985 100.000 % Yes  
(2) Alucent Australia Pty Ltd

Level 10 30 Collings Street
Melbourne,VIC 3000  
AS
Biotech Research AS Alucent Biomedical Inc
  		  531,683 247,493 70.200 % Yes  
(3) Alucent Biomedical Inc

1325 S Cliff Avenue PO Box 5045
Sioux Falls,SD571175045
47-1818349 		Biotech Research SD Alumend LLC
  		C -8,327,603 7,027,725 70.200 % Yes  
(4) Avera Property Insurance Inc

1000 West 4th Street Suite 1
Yankton,SD57078
46-0463155 		Insurance SD Avera Health
  		C -245,714 1,948,671 100.000 % Yes  
(5) DakotaCare Administrative Services Inc

5300 South Broadband Lane
Sioux Falls,SD57108
46-0424322 		Insurance SD Avera Health
  		C 200,847 366,501 100.000 % Yes  
(6) South Dakota State Medical Holding Company Inc

5300 South Broadband Lane
Sioux Falls,SD57108
46-0401087 		Insurance SD Avera Health
  		C 147,561 2,547,471 100.000 % Yes  
(7) Valley Health Services

501 Summit Street
Yankton,SD57078
46-0357149 		Rental Real Estate SD Sacred Heart Health Services
  		C 46,648 1,012,788 100.000 % Yes  
(8) Kore Cares In Home Services LLC

5300 South Broadband Lane
Sioux Falls,SD57108
88-2778902 		In-Home Care Services SD N/A
 S         No
Schedule R (Form 990) 2023
Schedule R (Form 990) 2023
Page 3
Part V
Transactions With Related Organizations. Complete if the organization answered "Yes" on Form 990, Part IV, line 34, 35b, or 36.
Note. Complete line 1 if any entity is listed in Parts II, III, or IV of this schedule.
Yes
No
1 During the tax year, did the orgranization engage in any of the following transactions with one or more related organizations listed in Parts II-IV?
a Receipt of (i) interest, (ii) annuities, (iii) royalties, or (iv) rent from a controlled entity .....................
1a
 
No
b Gift, grant, or capital contribution to related organization(s) ............................
1b
Yes
 
c Gift, grant, or capital contribution from related organization(s) ............................
1c
Yes
 
d Loans or loan guarantees to or for related organization(s) ............................
1d
 
No
e Loans or loan guarantees by related organization(s) ............................
1e
 
No
f Dividends from related organization(s) ............................
1f
 
No
g Sale of assets to related organization(s) ............................
1g
 
No
h Purchase of assets from related organization(s) ............................
1h
 
No
i Exchange of assets with related organization(s) ............................
1i
 
No
j Lease of facilities, equipment, or other assets to related organization(s) .......................
1j
 
No
k Lease of facilities, equipment, or other assets from related organization(s) ......................
1k
Yes
 
l Performance of services or membership or fundraising solicitations for related organization(s) .....................
1l
Yes
 
m Performance of services or membership or fundraising solicitations by related organization(s) .................
1m
 
No
n Sharing of facilities, equipment, mailing lists, or other assets with related organization(s) ...................
1n
Yes
 
o Sharing of paid employees with related organization(s) ............................
1o
Yes
 
p Reimbursement paid to related organization(s) for expenses ............................
1p
Yes
 
q Reimbursement paid by related organization(s) for expenses ............................
1q
Yes
 
r Other transfer of cash or property to related organization(s) ............................
1r
Yes
 
s Other transfer of cash or property from related organization(s) ............................
1s
Yes
 
2
If the answer to any of the above is "Yes," see the instructions for information on who must complete this line, including covered relationships and transaction thresholds.
(a)
Name of related organization 		(b)
Transaction
type (a-s) 		(c)
Amount involved 		(d)
Method of determining amount involved
(1) Avera McKennan

 K 184,011 Vendor Payment Listing
(2) Avera Health Plans Inc

 K 252,880 Vendor Payment Listing
(3) Avera Holy Family

 L 2,648,605 General Ledger
(4) Avera St Luke's

 L 17,760,642 General Ledger
(5) Avera Sacred Heart Health Services

 L 11,659,269 General Ledger
(6) Avera Marshall

 L 12,729,977 General Ledger
(7) Avera Queen Of Peace Hospital

 L 10,240,273 General Ledger
(8) Avera St Mary's

 L 9,626,428 General Ledger
(9) Avera At Home

 L 4,840,739 General Ledger
(10) Avera Health Plans Inc

 L 2,292,700 General Ledger
(11) St Benedict Health Center

 L 1,923,057 General Ledger
(12) Accounts Management Inc

 L 480,804 General Ledger
(13) South Dakota State Medical Holding Company Inc

 L 56,260 General Ledger
(14) Avera McKennan

 L 130,663,431 General Ledger
(15) Avera St Anthony's Hospital

 L 3,594,155 General Ledger
(16) Avera At Home

 O 222,130 General Ledger
(17) Avera St Mary's

 O 1,390,247 General Ledger
(18) Avera McKennan

 O 5,829,969 General Ledger
(19) Avera St Anthony's Hospital

 O 69,426 General Ledger
(20) Avera Sacred Heart Health Services

 O 1,183,111 General Ledger
(21) Avera St Luke's

 O 2,666,855 General Ledger
(22) Avera Health Plans Inc

 O 1,055,703 General Ledger
(23) Avera Marshall

 O 189,504 General Ledger
(24) Avera Queen Of Peace Hospital

 O 1,389,902 General Ledger
(25) St Benedict Health Center

 O 51,484 General Ledger
(26) Avera Marshall

 P 58,565 Vendor Payment Listing
(27) Avera McKennan

 P 5,853,626 Vendor Payment Listing
(28) Avera Health Plans Inc

 P 12,044,123 Vendor Payment Listing
(29) Avera St Luke's

 P 56,131 Vendor Payment Listing
(30) Avera St Luke's

 Q 6,865,759 Customer Invoice Listing
(31) Avera St Mary's

 Q 3,714,138 Customer Invoice Listing
(32) Avera Sacred Heart Health Services

 Q 4,666,606 Customer Invoice Listing
(33) Avera Queen Of Peace Hospital

 Q 4,433,490 Customer Invoice Listing
(34) Avera Marshall

 Q 2,613,308 Customer Invoice Listing
(35) St Benedict Health Center

 Q 382,987 Customer Invoice Listing
(36) Avera St Anthony's Hospital

 Q 1,025,944 Customer Invoice Listing
(37) Avera At Home

 Q 713,696 Customer Invoice Listing
(38) Avera Holy Family

 Q 594,722 Customer Invoice Listing
(39) Avera McKennan

 Q 91,572,374 Customer Invoice Listing
(40) Accounts Management Inc

 Q 186,389 Customer Invoice Listing
(41) Avera Health Plans Inc

 Q 68,075 Customer Invoice Listing
(42) Avera Sacred Heart Health Services

 R 512,361 General Ledger
(43) Avera McKennan

 R 3,078,531 General Ledger
(44) Avera St Mary's

 R 151,897 General Ledger
(45) Avera Marshall

 R 302,169 General Ledger
(46) Avera St Luke's

 R 192,405 General Ledger
(47) Avera Queen Of Peace Hospital

 R 314,154 General Ledger
Schedule R (Form 990) 2023
Schedule R (Form 990) 2023
Page 4
Part VI
Unrelated Organizations Taxable as a Partnership. Complete if the organization answered "Yes" on Form 990, Part IV, line 37.
Provide the following information for each entity taxed as a partnership through which the organization conducted more than five percent of its activities (measured by total assets or gross revenue) that was not a related organization. See instructions regarding exclusion for certain investment partnerships.
(a)
Name, address, and EIN of entity 		(b)
Primary activity 		(c)
Legal domicile
(state or foreign
country) 		(d)
Predominant income (related, unrelated, excluded from tax under sections 512-514)

(e)
Are all partners
section
501(c)(3)
organizations? 		(f)
Share of total income




 		(g)
Share of
end-of-year
assets 		(h)
Disproprtionate allocations? 		(i)
Code V-UBI
amount in box 20
of Schedule K-1
(Form 1065) 		(j)
General or
managing
partner? 		(k)
Percentage
ownership
Yes No Yes No Yes No






























Schedule R (Form 990) 2023
Schedule R (Form 990) 2023
Page 5
Part VII
Supplemental Information
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Schedule R (Form 990) 2023

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