Man and woman playing outside with a young boy flying a toy airplane.

Avera Annual Report 2025

Avera looks back at 2025 with gratitude for the many opportunities we’ve had to live out our Gospel values of Compassion, Hospitality and Stewardship.

Benefiting Our CommunitiesAvera benefits communities through vital partnerships to extend our mission, patient assistance programs, economic impacts, environmental and sustainability initiatives and more.
Developing Our PeoplePeople are Avera’s most important resource. We begin with workforce development and then through development of our employees as they live out the Avera mission and values.
Investing in Better Health CareAvera invests in people, programs, technology and infrastructure that enable us to carry out our health ministry with the latest technology and state-of-the-art space.
Celebrating ExcellenceDelivery of top quality health care and innovations that improve the patient care experience are worth celebrating.

Guided by Our Mission

Avera Health is distinguished by our faith-based health ministry and the quality of our 22,600 physicians and employees. With the compassion for which Avera is known, we deliver quality care through medical expertise and state-of-the-art technology. Through integration of services and innovative access points, we’re changing how health care is delivered.

Founded in 2000, Avera is celebrating our 25th anniversary in 2025. Avera is a regional health system comprised of 315 locations in 100 communities in five states across the Upper Midwest. Avera serves a population of 1 million throughout a geographical footprint of 72,000 square miles.

Avera is the health ministry of the Benedictine Sisters of Yankton, SD, and the Presentation Sisters of Aberdeen, SD. As a health ministry rooted in the Gospel, Avera’s mission is to make a positive impact in the lives and health of persons and communities by providing quality services guided by Christian values.

25th Anniversary Story

Benedictine and Presentation Sisters on the stairs at the Avera central office.

2025 Avera Health Board of Directors

Avera by the Numbers

  • 315sites of care
  • 100+communities
  • 5states
  • 72,000square mile footprint
  • 22,600employees
  • 2,200volunteers

A Message From Our Chief Executive Officer

Welcome to Avera’s 2025 Annual Report. Thank you for your interest in our health ministry.

This year is a special one for Avera as it marks our Silver Anniversary as a health system. Whether at a local picnic, regional annual meeting, or fall gala, we are celebrating this milestone in a big way. It marks the faithfulness of God to our health ministry, leading us to continue in the footsteps of our founding Sisters who opened their first hospitals over 125 years ago.

It also was a year when Avera came together as a system to launch our three-year strategic plan known as Illuminate. This was based on 10 months of work by 200 stakeholders to discover and identify priorities. Now, as 22,000 employees are implementing our strategic plan, we are excited to see growth, innovation and enhancements to patient care.

Keep reading to learn how Avera is committed to our communities, providing benefits in urban or rural locations alike. You’ll also learn about how we develop our people and invest in better health care for everyone.

Our ministry’s future is bright. We will continue to expand and meet the needs that are before our communities, now and in the future.

Jim Dover

Sincerely,

James F. Dover, FACHE
Avera President and Chief Executive Officer

A Message From Our Chief Philanthropy Officer

Collage with woman holding a baby in front new Women's and Children's building.The Avera Foundation is proud that 2025 was once again a record-breaking year. This pride is not in ourselves but in the amazing generosity we experience through thousands of benefactors.

Your support means the world to us, and through your kindness, you are creating a brighter future for those who depend on us in their time of need.

In the past year, Avera Foundation reached these milestones because of you:

  • Record fundraising of greater than $59.7 million and distributions of these funds
  • Employee giving that exceeded $7.5 million, illustrating the depth at which Avera employees participate in the mission of Avera to provide hope and healing
  • 21,038 supporters, including 4,296 first-time donors
  • 40 legacy gifts established, totaling more than $14 million
  • The largest philanthropic campaign in the region to support comprehensive women’s and children’s services through Tomorrow’s Promise
  • Building Hope Here campaign in Yankton to support local cancer services

Please read our annual Gratitude Report, a heartfelt expression of our appreciation and a chronicle of the lives touched through generosity. Please accept my deepest thanks: You are making a difference in the lives of those we serve every day.

We are sincerely grateful for you,

Dzenan Berberovic, Chief Philanthropy Office

Dzenan Berberovic
Avera Chief Philanthropy Officer

Benefiting Our Communities

Community benefit is an extension of non-profit hospitals' historic mission to meet the needs of the time in their communities, especially the needs of vulnerable and disenfranchised members in their communities. 

Examples of Community Benefit Provided by Avera

Charity Care and Financial Assistance

As part of our health ministry and mission Avera cares for all patients regardless of ability to pay. With support of patient advocates, people who are experiencing financial hardship can apply for assistance, and depending on their situation may receive medically necessary care with no obligations or discounted obligation.

Downtown Free Clinic

Since 1992, Avera has operated a free clinic in downtown Sioux Falls for uninsured patients. The Avera Health Care Clinic experiences just over 6,000 visits per year.

The Link

Avera collaborates with several community partners on The Link Community Triage Center, a facility offering support to individuals experiencing substance abuse disorder or a non-violent mental health crisis. Avera Behavioral Health holds the contract to provide daily operational services. Since opening in 2021, The Link has hosted over 15,700 triages, serving over 4,200 unique individuals and linking them to ongoing resources.

Careflight

Avera operates some of its programs at a financial loss to ensure that important services are offered. Careflight air transport is among those programs, because patients’ lives and optimal outcomes depend on getting to the right level of care in the case of a serious health event or injury. In the last year, Careflight provided over 2,600 transports with over 310,000 miles flown.

Friday Forums

Avera’s Friday Forums is an educational series specially designed to educate parents, as well as nurses, teachers, counselors, social workers and other disciplines who work with children and youth. Sessions are offered once a month, free of charge, through an online platform or via on-demand video. Topics have included anxiety, depression, substance abuse, technology, values and more.

Other Community Benefits

  • Community health services and screenings
  • Health professions education
  • Research
  • Financial and in-kind contributions
  • Community-building activities
  • Assistance for travel, prescriptions and housing for those who need support outside of their local facilities

Learn More About How Avera Benefits Communities

Community Health Needs Assessment

In keeping with the mission of Avera and as part of the Patient Protection and Affordable Care Act of 2010, tax-exempt hospitals are required to conduct community health needs assessments (CHNA) every three years. The CHNAs outline a community’s current health status, needs and priorities that tax-exempt hospitals plan and act upon to improve community health outcomes.

While these vary by community, top health needs identified across the Avera system include:

  • Behavioral health/substance abuse
  • Healthy lifestyle
  • Prevention and screening
  • Access to care

Read CHNA reports from Avera hospitals

Community Partnerships

Doctors and care teams can give the best care while people are within Avera facilities, but if they return to environments where they don’t have access to nutritious food, safe housing, transportation or education, we are only solving one piece of the puzzle. That’s why Avera partners with nonprofit organization that help us fulfill the Avera mission to have a positive impact in the lives of persons and communities.

Avera’s community partnerships program directs donations toward organizations that serve residents in areas that include food, housing, transportation, education, mental health and quality of life. Avera partners with 250+ organizations.

Examples include:

  • River City Transit: Provides low-cost transportation over a wide geographical region, assisting patients who wouldn’t otherwise have transportation to and from clinics and hospitals.
  • Yankton Pathways Homeless Shelter: More than a homeless shelter, Yankton Pathways offers in individuals help in finding a job and getting on the right path for their life.
  • Mitchell Safe Place and Aberdeen Safe Harbor: These organizations provide a safe place for women and families and a safe place for family visitation/exchanges for parents with visitation rights.
  • Sioux Falls Active Generations: While utilized primarily for seniors, Active Generations welcomes adults of all ages with social programs like organized activities and card clubs, fitness activities like pickleball, educational opportunities, as well as dine-in meals, Meals on Wheels, respite care, adult day services and more.
  • Feeding South Dakota: Avera has been a long-term partner with this agency to provide adequate and nutritional food to people in the state with food insecurity. Most recently, Avera has been helping with distribution partners, including clinic-based food pantries at Avera locations.

By the Numbers

$23,594,000
 Charity care/financial assistance at cost

$54,037,000
 Unpaid costs of government programs

$90,741,000
 Additional community benefits

$168,372,000
 Total

Avera Gettysburg

Avera's Economic Impact

Not only concerned about individual health and well-being, health care systems like Avera are among the top private employers across the upper Midwest.

  • Health care is a major source of employment and earnings, and Avera is a top employer in multiple rural communities. In the past decade, our payroll has grown from 16,000 employees in 2015 to 22,600 employees in 2025.
  • The health care industry is projected to be among South Dakota's largest growth industries to 2032, adding nearly 8,000 workers to the state’s economy with a growth rate exceeding 13%

Source: South Dakota Department of Labor & Regulation, South Dakota Health Care Workforce Trends, 2024

Avera's Commitment to Rural Health Care

Avera’s integrated health system is designed for the delivery of rural health care, with locations in more than 100 communities. By addressing and overcoming rural health disparities, we build better access to quality health services for all patients. Rural Health Care

Environmental, Social and Governance

The ESG Committee at Avera considers our ongoing commitment to environmental impact, social responsibility and ethical governance practices to enhance patient care, community well-being, and long-term sustainability.

  • Environmental: Avera is furthering our value of stewardship by reducing our carbon footprint and advocating for the integration of sustainable practices to positively impact patients and staff.
  • Social: Avera prioritizes patient well-being, prevention, social determinants of health, equity, fair and just treatment of patients and staff, promoting a positive work culture and more.
  • Governance: We strive to ensure transparency, accountability and ethical decision-making, including data protection and privacy.

Learn More About ESG at Avera

Stories About Our Community Impact

Rows of food on shelves in food pantry. Avera Collaborates with Feeding SD to Offer Clinic Food Pantries Through a pilot project, Avera is offering clinic-based food pantries for patients who experience food insecurity.
Three female health care workers in training scenario with infant test model.Collaborative Training to Improve Maternal Health Outcomes Researchers and health providers go into communities to provide training opportunities to help improve outcomes for moms and babies.
Group of health care workers discussing rural health care in patient care area.How Avera Supports Rural Care Teams in the Face of Trauma Rural trauma training helps local emergency room staff ensure they are prepared with the right equipment and the right protocols.

Developing Our People

Four smiling health care workers talking in the hallway.Health care is a people-centered industry. For Avera, people are our No. 1 resource.

Competent, skilled and well-trained staff who demonstrate care and compassion are vital in the delivery of quality health care. Certain professions are highly needed, including nurses, certified nursing assistants, medical lab techs and scientists, respiratory therapists, surgical techs and imaging professionals.

Learn about sponsorships and scholarships at Avera

Workforce Development Programs

Avera begins developing workforce at the high school level and earlier, helping students to see that opportunities in health care are wide open. Collaboration with educational institutions and other partners helps to further Avera’s workforce development efforts.

FARM Program

Avera participates in Frontier And Rural Medicine (FARM), a rural track for medical students at the University of South Dakota School of Medicine. This is a unique opportunity for a select group of third year students to complete 11 months of their clinical training in rural communities.

Avera locations in several communities are training sites, including Chamberlain, Milbank, Parkston and Pierre.

“Training in rural communities offers the opportunity to experience increased hands-on education and provides a unique view of the rewards and challenges of practicing in a rural setting.”

- Jason Wickersham, MD, family practitioner in Parkston and associate dean of the program

Avera Nursing Sponsorships

The Avera Nursing Advantage program, which aims to provide an affordable pathway into nursing for more people in our region, named Mount Marty University as a preferred educator of future Avera nurses, recognizing the long history of collaboration between the two Catholic ministries. Selected junior and senior nursing students at Mount Marty receive a generous sponsorship and the ability to work within the Avera Health system after earning their bachelor’s degree in nursing.

Collaboration with the Nano Nagle Online School of Nursing at St. Ambrose University provides nursing students with sponsorship dollars to help pay tuition costs with a three-year work commitment.

Nursing Degree in Three

Avera, Bishop O’Gorman Catholic High School and Mount Marty University have collaborated to create the Nursing Degree in Three program, an opportunity for O’Gorman students to potentially graduate with a bachelor of science in nursing (BSN) in three years.

The program has the benefit of generating a pipeline of well-trained nurses with roots in South Dakota. O'Gorman High School students can begin taking specific advanced placement (AP) and dual credit courses through Mount Marty in their junior year, which can count as credit for a BSN degree. If they take all the prescribed classes, they will graduate from Mount Marty with a BSN in three years instead of four.

NSU Sim Center

In partnership with Avera, Northern State University in Aberdeen is developing an advanced simulation center. This simulation center will be a core part of Northern’s Bachelor of Science in Nursing (BSN) program.

The center will be housed within the new Business and Health Innovation Center, currently under construction with a December 2025 expected completion date. The center includes six simulation suites and an eight-bed skills lab, both equipped with tools like realistic patient manikins and virtual reality, helping students learn in a hands-on, immersive environment.

Avera Academy

The Avera Academy allows high school students to earn high school and college credit hours while gaining real-time exposure to careers in health care. It’s a collaboration between Avera, Sioux Falls Public Schools and Southeast Technical College.

Each year, program leaders select 24 high school seniors from the Sioux Falls School District to take part. They spend Friday mornings at Avera facilities where they explore health care careers and see first hand what health care professionals do. Avera Academy has been expanded to other regions within the Avera system in different versions that fit their needs, for example, day camps.

SDARL Sponsor

Avera is a sponsor of the South Dakota Agricultural and Rural Leadership Program (SDARL), which takes a cohort of adult learners on an 18-month leadership journey, with a new class seated every two years.

Seminars are held across South Dakota, as well as Washington, D.C., and time spent in a foreign country to examine the global nature of agriculture and the challenges of feeding the world. Participants emerge from the program prepared to lead their communities and the state, and make significant contributions to agriculture nationally and globally.

Marshall Partnership for Nursing Education

In response to increasing demand from prospective students, the Southwest Minnesota State University (SMSU) Nursing Department is developing a four-year bachelor’s degree in nursing in partnership with Avera Health. SMSU currently offers the RN to BSN program as well as the master of science in nursing education. By combining the clinical expertise of Avera with the academic excellence of SMSU, the program will deliver a robust educational experience that meets the highest standards of health care education.

Avera and SMSU are exploring ways our organizations could partner around simulation lab resources, clinical rotations and more.

Avera People Make All the Difference

Avera Responds to O'Neill Explosion

On Oct. 7, 2024, Avera St. Anthony’s Hospital in O’Neill, NE, experienced significant damage from an explosion near the campus. Thankfully, there were no major injuries to patients or staff, and the damage was limited to the building.

First responders from O’Neill and the surrounding areas, as well as Avera St. Anthony’s leaders and employees, made a difference with their quick action.

Avera teams in Risk Management, Human Resources, Communications and Construction Management also played vital roles in our response. Avera’s response to this incident highlights the value of our collaboration and strength of the system.

Patient area showing damage after the explosion.

I-90 Bus Accident Near Pierre

On Saturday, March 29, 2025, a passenger bus rolled over on Interstate 90 near Vivian, SD, due to slick road conditions. Freezing fog and snow created a challenging environment for both first responders and ambulance teams. What stood out in those difficult moments was the extraordinary teamwork displayed at Avera St. Mary’s Hospital by staff and the entire community.

The team received word of the accident around 5:30 PM and immediately began preparing for what could be a major crisis, with surgery and emergency staff on standby. The strength of the team allowed us to provide 10 patients with the treatment they needed in a time of crisis – an example of rural health care at its finest.

Avera St. Mary's staff gather in hospital patient area during response to I-90 bus accident.

Health Care Careers

Help deliver superior health care or provide outstanding support for those who do at Avera. Search Careers

Investing in Better Health Care

Avera invests in people, programs, technology and infrastructure that enable us to carry out our health ministry with the latest technology and state-of-the-art space.

Women’s and Children’s

As construction continues on the campus of Avera McKennan Hospital & University Health Center in Sioux Falls, the new six-story tower to house women’s and children’s services is taking shape.

Together with a new medical office pavilion at the Avera on Louise Health Campus, this represents the largest building project in Avera history at a cost of $245 million and 350,000 square feet of new patient care space.

Along with creating space to enhance and expand women’s and children’s care, the project is creating a new welcoming entrance to the hospital. The new tower building addition will provide a state-of-the-art home for the excellent care Avera is already providing through an expert team.

A $50 million fundraising campaign, Tomorrow’s Promise, is the largest philanthropic campaign in the region to support comprehensive women’s and children’s services.

New Avera Women's and Children's artist rendering.

Behavioral health lobby.

Behavioral Health Expansion

Avera St. Luke’s Hospital in Aberdeen, SD, has opened a new 18-bed Behavioral Health Unit in remodeled space in the existing hospital. The unit will serve adults and provide crisis stabilization for adolescents.

The new unit provides 18 private rooms, plus space for gym and activities as well as therapy groups. Avera St. Luke’s continues to offer residential addiction care in the hospital.

This project provides state-of-the-art space for the excellent behavioral health staff and effective programming already in place at Avera St. Luke’s.

In Sioux Falls, Avera opened a new adult inpatient unit at the Avera Behavioral Health Hospital to meet increasing demand for high quality behavioral health services.

This project entailed finishing shell space in the Helmsley Behavioral Health Center wing completed in 2021, adding 16 beds for adult care.

Digestive Disease Pavilion

At the Avera on Louise Health Campus in Sioux Falls, Avera is building a new medical office pavilion to house gastroenterology services. Projected completion date is early 2026.

When the pavilion is complete, Avera will refit former GI space in the Avera Specialty Hospital for the in-demand specialty of orthopedics, meaning that a greater portion of the specialty hospital will be dedicated to orthopedic clinic visits and surgical procedures.

The new pavilion will offer more general GI procedure rooms for uses such as colonoscopy and endoscopy, plus two advanced procedure rooms.

New Digestive Disease Pavilion aerial photo of building and parking lot.

Avera McKennan campus expansion.

Additional Avera McKennan Expansion Projects

Construction of the six-story tower for Women’s and Children’s services will allow for other expansion and enhancements at Avera McKennan.

  • When women’s and children’s services move into the new addition in early 2027, former space will be remodeled and refitted to provide much needed medical/surgical beds.
  • Avera’s Inpatient Rehabilitation Unit moved to Avera Specialty Hospital on the Avera on Louise Health Campus. This allowed space for the inpatient oncology unit to be moved to the fifth floor of the Prairie Center. Thanks to this move, more cancer services are offered in at one convenient and patient-centered location,
  • Plaza 3 on the Avera McKennan campus was taken down to make room for the new addition. Clinics have moved to Plazas 2 and 4 on the hospital campus, as well as the Dawley Farm location.
  • A new location for the Avera Dialysis Center provided space for more patient stations, convenient retail-style parking and easy access to the front door.

Avera Continuum of Care

Infographic various statistics.

2025 by the Numbers

  • 43,468inpatient discharges
  • 1,235,708outpatient visits
  • 2,093,107clinic visits
  • 3,372,283total patient visits

Celebrating Excellence

25 Years of Health Ministry

In 2025, Avera celebrates 25 years of health care delivery in accordance with its mission.

Not long after the Benedictine and Presentation Sisters arrived in Dakota Territory in the 1880s, their mission of education expanded to include health care in the face of great needs, including a diphtheria epidemic. Each founded hospitals and nursing homes and formed systems. In the 1990s, they began considering how both systems could come together for the benefit of all, resulting in a unique co-sponsorship model founded on Sept. 1, 2000.

Across a 72,000-square-mile footprint, the name Avera represents system strength and local presence, clinical excellence, compassion, mission, technological sophistication and an array of specialties, in addition to a commitment to wellness and prevention.

Illuminate strategic plan and description.

Illuminate Strategic Plan

In early 2025, Avera rolled our three-year strategic plan for 2025 through 2027, known as Illuminate.

Our strategic plan is a roadmap that sets direction and focus for Avera. It’s a framework for making consistent, aligned decisions that move us toward our envisioned future with growth, quality enhancements, innovative care and deeper community engagement.

Our entire plan looks to this strategic aspiration: to be a Nationally Leading Rural Integrated Health Care Delivery Network. This aspiration fulfills our mission as we seek to make a positive impact in the lives and health of persons and communities at all locations, rural and urban alike.

Together, the people of Avera are part of something bigger than ourselves. Together, we can achieve great things and ensure Avera continues to grow and have vibrancy as the healing ministry of Jesus.

Enhancing the Patient Care and Experience

Epic Electronic Health Record

The Avera system is transitioning to Epic for its electronic health record (EHR) vendor. This decision marks a pivotal moment in our commitment to providing the highest standard of care and operational excellence. The Epic EHR will go live in the summer of 2026.

Epic features include an extensive patient portal, as well as numerous telehealth options – from supporting video visits and post-surgical follow-ups to patient monitoring. This cloud-based EHR offers features that enhance the patient experience and the patient-doctor relationship.

Through the portal, patients will be able to schedule appointments online, share their health information, access test results and pay bills. Clinicians in a wide range of specialties will benefit from strong clinical decision-making support and a platform for care continuity.

Patients’ current AveraChart patient portal will remain fully operational, with a seamless transition at the time of go-live.

Avera’s Quality Journey

At Avera, providing quality care is our top priority. Avera embraces the philosophy of a just culture that encourages the development of systems that support delivery of excellent care to each and every patient.

Avera continues to expand the quality and safety focus throughout the continuum of services, including our hospitals, primary and specialty care clinics, home care and long-term care.

Every two years, Avera’s Quality team develops a system-wide, cross continuum Quality Plan, with the current one in effect through 2025. The Quality Plan brings together the Avera mission with the Avera Strategic Plan and Centers for Medicare & Medicaid Services (CMS) National Quality Strategy with the goal of benefiting patients with higher quality, safer and more affordable care.

Integration through Avera Health Plans

Avera Health is an integrated system of care. This means that our hospitals, clinics, physicians, leaders and our health insurance company all work together for the benefit of our patients.

For Avera, the members of Avera Health Plans are an important population group that we take care of. This includes coverage for individuals and families, small and large employer groups, and Medicare Supplement Insurance.

Great care begins with prevention, and ensuring that members receive the full benefit of their health insurance plan when it comes to preventive care like yearly check-ups and health screening tests and exams. Access to 60+ medical specialties ensures members can get the care they need close to home.

Our health insurance company knows our physicians and clinicians, and likewise, our care teams know our insurance plans. We work together for better health and well-being for all who choose Avera In the past year, Avera Health Plans made these enhancements available to members, depending on their plan:

  • Avera Health Plans Rx is a new pharmacy benefits manager (PBM) that offers access to most local pharmacies, more than 56,000 online pharmacies and transparency tools to cut medication costs.
  • Virtual visits for urgent care and behavioral health
  • Heart and vascular screenings through Planet Heart
  • Virta, a virtual clinic that can help members lose weight, reduce medications and manage type 2 diabetes at no extra cost to the members

Landmann-Jungmann Converts to New Rural Status

The local governance board of Landmann-Jungman Memorial Hospital in Scotland, SD, made the decision to convert from critical access hospital status to Rural Emergency Hospital (REH). REH is a new provider type designed by the Centers for Medicare & Medicaid Services (CMS). This change took effect July 1, 2025, and is the first REH in the state of South Dakota.

This designation looks to innovative payment reform and prioritizing close alignment between outpatient services and rural community health care needs.

The main change will be discontinuation of hospital acute care and swing beds. Landmann-Jungman currently has a low average daily census for inpatient hospital care of less than one patient. Health care has made a significant shift to outpatient services which is still offered.

Landmann-Jungman will continue to offer all other services including 24/7 emergency room, observation beds, therapy, radiology (imaging), and outpatient injections/infusions. Local clinic services remain the same.

Awards and Recognition

Quality awards are validation of the high quality offered by Avera facilities in realms of clinical excellence, patient safety and patient experience.

  • No. 1 health system employer for South Dakota by Forbes in its ranking of Best Employers by State 2024 and 2025
  • Avera McKennan received its sixth consecutive Magnet® recognition for nursing excellence
  • Human Experience (HX) Guardian of Excellence Award®, received by Avera McKennan Emergency Departments
  • 5-Star Hospitals as recognized by the Centers for Medicare & Medicaid: Avera St. Luke’s Hospital and Avera Heart Hospital
  • Numerous Top 100 hospitals throughout our footprint, and two Top 20, and numerous Performance Leadership Awards as recognized by Chartis and the National Rural Health Association.
  • Avera@Home: O’Neill, NE and Mitchell, SD: Patient Satisfaction Award; Aberdeen, SD and Spencer, IA, Caregiver Satisfaction Award, from Strategic Healthcare Programs.

View Other Awards

Generosity Makes a Difference.

Support your community’s health by giving to lifesaving services. Donate to the Avera Foundation. Donate

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