2023-05-12T10:38:32-05:00 2022-06-30 450250958 Eide Bailly LLP 800 Nicollet Mall Ste 1300 Minneapolis MN 554027033 990 2021-07-01 843156881 Avera Granite Falls AVER 3205646200 345 10th Ave Granite Falls MN 56241 Julie Lautt CFO Avera Health 3205646200 2023-05-09 1 Julie Lautt 999009999 Kim Hunwardsen CPA P00484560 6122536500 2023-05-04 3 AAL1 IAL1 2021 2023-04-26 12:10:37Z Avera Granite Falls Health Center Debbie Streier 345 10th Ave Granite Falls MN 56241 29259649 0 X See Schedule O X 2019 MN Promotion of health 7 5 253 6 0 0 1924390 1382678 26132431 27740373 379995 59014 92748 60744 28529564 29242809 706 35 0 0 14252614 14371387 0 0 0 13251074 13946941 27504394 28318363 1025170 924446 28331941 26933854 13699732 12629986 14632209 14303868 X Avera is a health ministry rooted in the Gospel. Our mission is to make a positive impact in the lives and health of persons and communities by providing quality services and guided by Christian values. 0 0 23686720 35 27763045 Avera Granite Falls' mission is to provide healthcare services to Granite Falls, Minnesota residents and residents of the surrounding area. Avera Granite Falls is a 501(c)(3) organization affiliated with Avera Health and controlled by Avera Marshall. Avera Granite Falls consists of a 25-bed critical access hospital, a 48-bed nursing home, a 28-unit senior living facility in Granite Falls, Minnesota, and one physician clinic. The program services offered include primary care, med/surg, lab, imaging, physical therapy, speech therapy, occupational therapy, respiratory therapy, ambulance, special transportation, ER, telehealth, infusion, general surgery, chemotherapy, cardiac rehab, long term care and independent living. Following is a breakdown of these statistics by facility:Avera Granite Falls Health Center173 Acute patient discharges14 Newborn patient discharges63 Swing bed patient discharges11,069 Outpatient visits424 Swing-bed patient days17 Newborn patient days18,316 Clinic visitsAvera Granite Falls Care Center17,354 Long-term resident days20 Long Term Care patient dischargesAvera Granite Falls maintains records to identify and monitor the level of charity care it provides. These records include the amount of charges forgone for services and supplies furnished under its charity care policy and equivalent service statistics. The amount of charges foregone, based on established rates, were $92,742.Avera Granite Falls also provides community benefit health activities at less than or at no cost to support those in the area serviced, see Schedule H. As a member of the Avera Health Network, Avera Granite Falls upholds the vision of the Presentation and Benedictine Sisters to work through collaboration to provide quality, effective health ministry and to improve the healthcare of individuals and our communities through a regionally integrated network of persons and institutions. Avera Granite Falls engages in activities designed to improve the health of individuals and communities in response to a calling to heal the sick, the elderly, and the oppressed. 23686720 1 1 0 1 0 0 0 0 0 0 1 1 0 1 1 1 0 1 0 0 0 0 0 0 0 0 1 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 34 0 1 253 1 0 0 0 0 0 0 0 0 0 0 0 0 X 7 5 1 0 0 0 1 1 1 1 0 0 0 1 1 1 1 1 1 0 0 0 MN X Jamie Schaefer 6053223992 3900 W Avera Dr Ste 300 Sioux Falls SD 57108 Lavonne Koenen Chair 2.00 3.00 X X 0 0 0 Mark Jensen Vice Chair 2.00 0.00 X X 0 0 0 Sister Lucille Welbig PBVM Director 2.00 5.00 X 0 0 0 George Jorgensen Director 2.00 3.00 X 0 0 0 Tom Kooiman Director/Administrator 42.00 0.00 X X 251621 0 46957 Sharon Pazi Zea Director 2.00 0.00 X 0 0 0 Debbie Streier President/CEO 2.00 42.50 X X 0 473161 40327 Dr Mark Eakes - Left 122021 Director 2.00 41.50 X 0 483003 45634 Julie Lautt CFO Avera Health; Sec/Treas 0.10 46.30 X 0 1051228 16194 Jennifer Ann Jager Assistant Director - Ambulance 40.00 0.00 X 135419 0 17348 Deena Aus Director - Patient Care Services 40.00 0.00 X 108745 0 44722 Shelby McNeil RN - LTC 40.00 0.00 X 106001 0 48413 Mary Maertens Former President/CEO 0.00 40.00 X 0 372706 39838 Val Hoffman Former CFO 40.00 0.00 X 157912 0 22996 759698 2380098 322429 5 1 1 0 Avera Marshall 300 S Bruce Street Marshall MN 56258 Physicians and Shared Services 3452939 Big Stone Therapies Inc 500 Cross St Big Stone City SD 57216 Therapy Services 1126358 Central Minnesota Diagnostic Inc 525 10th St NE PO Box 158 Milaca MN 56353 Radiology Services 349511 Avera Health 3900 W Avera Dr Ste 301 Sioux Falls SD 57108 Shared Services 265641 CentraCare Health 1406 6th Ave N St Cloud MN 56303 Physician Services 217785 6 232541 1143637 6500 1382678 Patient Service Revenue 622110 26673791 26673791 Pharmacy Revenue 900099 471319 471319 595263 595263 27740373 35294 16840 18454 18454 18454 42414 16600 0 0 42414 16600 59014 59014 A/R Interest Income 900099 22672 22672 19618 19618 42290 29242809 27763045 0 97086 X 35 35 299591 299591 11420293 11364796 55497 401228 399149 2079 1472981 1461671 11310 777294 760067 17227 696 696 338 338 6664226 4887195 1777031 4610 417 4193 435836 162290 273546 214076 56002 158074 641177 574065 67112 124582 115032 9550 59322 53969 5353 326 326 932288 491054 441234 113880 16763 97117 Medical Supplies 2905381 2903048 2333 Equipment Lease/Rental 74681 70087 4594 1775522 370754 1404768 28318363 23686720 4631643 0 898794 792418 9237955 3389064 527678 461980 246784 177097 5595870 2130325 3798135 3465545 3203393 8536502 37500 25000 10381702 10086248 28331941 26933854 2203553 1843981 284420 0 14640 10098 11197119 10775907 13699732 12629986 X 14250135 14165251 382074 138617 14632209 14303868 28331941 26933854 X 924446 -1008603 -244184 X X 0 1 X 1 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 338 338 0 Part II-B, Line 1: Avera Granite Falls paid dues to organizations which have a portion of the dues attributed to lobbying activities. 0 1 X 69545 14186 55359 5507482 2116139 3391343 18843 18843 3465545 Avera Pooled Investments 7937049 F Investments in Affiliated Organizations 454802 F Interest in Avera Health Foundation 144651 F 8536502 Right of Use Asset 9874740 Intercompany Receivables 211508 10086248 Third Party Payor Settlements 443318 Right of Use Operating Lease Obligations 10099339 Deferred Payroll Taxes 215249 Capital Lease Obligations 3351 Security Deposits Payable 14650 10775907 X Part IV, Line 2b: The Organization holds funds on behalf of its residents. 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. 1 1 X 1 X 250.000000000000 1 X 1 1 1 0 0 43886 43886 0.00150 4493669 4131656 362013 0.01280 4537555 4131656 405899 0.01430 819 819 0.00000 9388592 3618399 5770193 0.20380 63504 24968 38536 0.00140 9452915 3643367 5809548 0.20520 13990470 7775023 6215447 0.21950 710 710 0.00000 710 710 0.00000 1 1293213 5246563 5202396 44167 X 1 1 1 1 Avera Granite Falls 345 10th Avenue Granite Falls MN 56241 See Part V 395031 X X X X 1 Provider Based Clinic Avera Granite Falls 1 0 0 1 X X X X X X X X X 21 1 1 1 1 X See Part V Section C X See Part V Section C X 1 21 1 See Part V Section C 0 1 X 250.000000000000 400.000000000000 X X X X 1 1 X X X 1 X See Part V Section C X See Part V Section C X See Part V Section C X X X X X X X 1 X 0 X X X X X 1 X 0 0 Avera Granite Falls Part V, Section B, Line 5: The Avera Granite Falls Community Health Needs Assessment (CHNA) was conducted in collaboration and partnership with community members, community organizations, stakeholders from local public health and internal stakeholders. These partners assisted in the development and analysis of assessment information through a series of data collection processes. In addition, Avera Marshall Region (Avera Marshall, Avera Tyler, and Avera Granite Falls hospitals) partnered with Southwest Health and Human Services (SWHHS) to provide a more comprehensive look into the social determinants of health and wellness in the communities we serve. SWHHS shared their draft of their 2019 Quality of Life Survey with us, which allowed us to incorporate the perspectives of 488 individuals on what defines a healthy community. In addition, we talked to 82 community members of diverse backgrounds and used a five member CHNA advisory committee that represented various aspects of our service area: academic, governmental, non-profit, industry, and vulnerable populations. Care was taken to consider the perspectives of the underserved populations: Karen, Hispanic/Latino, African American, and Somali. We also consulted with Vondie Woodbury of The Woodbury Group. Avera Granite Falls Part V, Section B, Line 6a: The Avera Marshall region has three hospitals: Avera Marshall, Avera Tyler, and Avera Granite Falls. As it is that all three hospitals are in the Avera Health system, share equally the same demographic and geographic area, and have shared senior leadership, the conducted CHNA was a regional CHNA that was inclusive of all three hospitals. Additionally, the implementation plan established applies to all three facilities. Avera Granite Falls Part V, Section B, Line 6b: Southwest Health and Human Services Avera Granite Falls Part V, Section B, Line 11: Avera Granite Falls, like all healthcare facilities across the world, was impacted by the COVID-19 pandemic. Not only has the pandemic taken a toll on human life and well-being of communities, but it has also brought major upheavals in healthcare institutions, which continue to this day. During the two plus years of the pandemic, COVID-19 required hospitals and clinics to focus most of their time and resources on dealing with pandemic related illness, staffing shortages, and financial strain. Despite difficulties brought by COVID-19, Avera Granite Falls continued to provide and improve greater access to a full spectrum of mental health services, which was the first priority of the facility. The progress made with mental health services over the past three years, including continued work in 2022, included: Partnered with Western Mental Health Center (WMHC) and Southwest Health and Human Services (SWHHS) and law enforcement on crisis situations that occur within our region. This includes follow up with either post-hospitalization or post-ED visit with WMHC's Co-responder Program. Continued work with WMHC on improving relationships and referrals between programs and providing education to providers on programs/services that are offered at WMHC. This included discussions about opportunities to improve their Zero Suicide Program and/or create consistency across our region's programs. Our collaboration with WMHC included coordinating care and follow-up for patients with substance use issues. Worked with the VA in organizing both the Marshall Area Suicide Prevention Coalition and the Upper MN River Valley Suicide Prevention Coalition. Collaborated with the Avera Behavioral Health service line to add social service positions in the region to ensure psychosocial needs of patients are being met across care settings. These additional services have created resources for behavioral health services/resources that can be used by providers throughout the region which has helped increase admissions directly to our behavioral health unit in Marshall, which decreases the need for patients to be transferred elsewhere. Worked with the Avera Foundation and United Community Action to partner in offering transportation vouchers to patients who need care at the Avera Marshall Behavioral Health facility, but do not have means of transportation home. Avera Marshall region serves as a pilot site for the Avera Medical Group to track depression amongst our inpatient and outpatient Medicaid populations. This pilot program is a joint effort between Avera Marshall and WMHC. A new community health needs assessment was completed in FY2022. The following community health priority areas were identified: Cultural barriers that impact healthcare, including but not limited to interpretive services; Mental Health; and Transportation, as it relates to access for healthcare services. Avera Marshall developed an implementation plan for each of these three priorities. Mental Health: Avera Granite Falls' goal around mental health will be to lower depression rates and engage in issues around suicide prevention. Partners we are working with: Public Health, Clergy, Community Groups, Southwest Mental Health, AMG general practice providers, schools, and AMG Mental health providers. Steps we are taking: Avera Medical Group (AMG) tracks depression amongst our inpatient and outpatient Medicaid populations. AMG providers discuss depression with patients who show signs of depression and help connect them with our mental health services. Working with Southwest Mental Health by informing mental health patients of the resources provided by the agency, especially their mobile mental health crisis team. Utilizing Minnesota Department of Health (MDH) resources related to the 988 mental health hotline in our community education events. Conducting a community wide suicide prevention campaign called, "Ask the Question" to provide community members information about how to talk to friends and family about suicide in order to reduce the risk of suicide. This program is engaging public health, providing education to church leaders, and delivering public service messages. Cultural barriers that impact healthcare, including but not limited to interpretive services:Avera Granite Falls' goal around cultural barriers is to improve interpretive services, provide assistance in navigating the healthcare system, and educate our traditionally underserved populations in matters related to disease prevention and vaccinations. Partners we are working with: Public Health, Non-Avera Medical Providers, Churches, Community Groups, Local Employers, Medical Providers, ARCH Language Network, and Avera Staff. Steps we are taking: We are increasing access to in-person interpreters. One way is to develop a program where current staff who are bilingual in Karen, Somali, or Spanish have the opportunity to cross-train as certified medical interpreters. We have hired a Karen community health worker (CHW). Our goal over the next three years is to hire two additional CHWs for the Somali and Hispanic populations. Developing a relationship with a local medical provider who is part of the Somali community. Strengthening relationships with local employers who employ members of traditionally underserved populations in order to collaborate to provider health education opportunities and on-site vaccine clinics. Provided health related education for the Karen community by presenting information about health-related topics prior to their Sunday worship services. Partnering with Avera Foundation to develop spaces for interfaith reflection throughout our facilities (i.e., meditation rooms) to support spiritual well-being. Transportation, as it relates to access for healthcare services:Avera Granite Falls' goal is to improve transportation access for health care appointments for those who do not have transportation and develop stronger relationships with transportation services within our service area. Partners we are working with: Local and State Public Health, City of Marshall, United Community Action Partnership, Local Medical Transport Companies, and Avera Staff (CHW and Care Coordination). Steps we are taking: Working with the City of Marshall and public health to provide a bus stop at the Federally Qualified Health Center (FQHC). Added to the Karen CHW job responsibilities to arrange transportation for the Karen patients who do not have complex care coordination needs. This allows care coordination to focus on more complex cases and will allow the CHW to provide more targeted intervention on transportation for Karen community members. Meeting with public health and local medical transportation companies (including volunteer programs) to engage in dialogue about how we can best work together to provide short and long-distance transportation for medical services throughout the region. When emergency medical transportation is utilized, providing clear directions to family and friends of the patient to the destination facility. Additionally, when those family and friends do not have transportation have social work/care coordination find a local transport company to bring at least one family member to the destination facility.There are needs identified in the Community Health Needs Assessment which Avera Granite Falls has not included in its priority implementation plan. These needs were not included in the priority needs implementation plan in order to focus resources on the three most urgent health care needs. The needs not being directly addressed include: alcohol and drug abuse, cancer, and aging problems. We continue to address these needs throughout the Avera Marshall Region using the appropriate standards of care. Avera Granite Falls Part V, Section B, Line 13h: Presumptive charity care may be applied in situations where all other avenues of financial assistance have been exhausted. The facility has the discretion to weigh extenuating circumstances when determining eligibility for and the amount of charity care to provide. Avera Granite Falls Part V, Section B, Line 16j: A summary of the financial assistance policy is posted in the hospital facility's emergency rooms, waiting rooms, andAvera Granite Falls admissions office and included on the billing statement. In addition, the financial assistance policy is discussed with the patient upon admission to the facility. Avera Granite Falls Part V, Section B, Line 20e: If a patient is self-pay and has a large balance, an Avera patient advocate will help them apply for other forms ofassistance. If they are not eligible for any other coverage, the patient is given a financial assistance application to complete and return to the facility. Avera Granite Falls Part V, Section B, Line 24: The hospital financial assistance policy does not cover elective procedures. The hospital may have charged FAP eligible patients gross charges for services that are not covered under the financial assistance policy. Schedule H Part V, Section A organization's website: avera.org/locations/avera-granite-falls-health-center/ Part V, Section B, Lines 7a, 7b and 10a: https://www.avera.org/about/community-health-needs-assessments/#granitefalls Schedule H Part V, Lines 16a, 16b, and 16c: avera.org/patients-visitors/charity-patient-assistance-programs/financial-assistance-forms/ 2 1 - Avera Granite Falls Care Center 250 Jordan Dr Granite Falls MN 56241 48-bed Skilled Nursing Facility 2 - Avera Granite Ridge Senior Living 500 Skyview Dr Granite Falls MN 56241 28-unit Independent Living Apartments Part I, Line 3c: The methodology used to determine eligibility for financial assistance takes into consideration income, net assets, family size and resources available to pay for care. In addition, presumptive charity care may be applied in situations where all other avenues have been exhausted. Part I, Line 7: Charity care was converted to cost using an overall cost-to-charge ratio addressing all patient segments. Unreimbursed Medicaid was calculated using the costing methods to prepare the cost report. Subsidized health services were calculated based on a combination of the Medicare cost report and actual expenses recorded to the general ledger. Community health improvement services are reported based on actual expenses recorded to the general ledger. Cash and in-kind contributions are reported based on actual expenses recorded in the general ledger. Part I, Line 7g: Rural health clinic costs are included in subsidized health services. Revenues of $2,977,574 and costs of $5,449,431 were included for a net community benefit of $2,471,857. Part II, Community Building Activities: Avera Granite Falls participates in nonprofit organizations for the betterment of the community. Part III, Line 2: The amount on line 2 represents implicit price concessions. The Organization determines its estimate of implicit price concessions based on its historical collection experience with the respective class of patients and residents. Part III, Line 4: The footnote to the Organization's financial statements that describes implicit price concession is located in the audited financial statement report on pages 19 and 20. Part III, Line 8: Avera Granite Falls provides services to patients under the Medicare program knowing they may not recover all the costs associated with providing these services. Providing these services is essential to these patients and the community and increases their access to healthcare services. Therefore, in years the costs associated with services provided under the Medicare programs are not completely covered, the Medicare shortfall is considered a community benefit.Medicare allowable costs of care are based on the Medicare cost report. The Medicare cost report is completed based on the rules and regulations set forth by Centers for Medicare and Medicaid Services. Part III, Line 9b: If the patient qualifies for the organization's financial assistance policy for low-income, uninsured patients and is cooperating with the organization with regard to efforts to settle an outstanding bill within current self-pay collection policy guidelines and timeframes, the organization or its agent shall not send, nor intimate that it will send, the unpaid bill to any outside collection agency. Avera organizations will allow all individuals 120 days from the first post discharge statement to apply for financial assistance before sending the uncollected account to an outside collection agency. Avera will provide the patient with a statement or final notice that contains a listing of the specific collection action(s) it intends to initiate, and a deadline after which they may be initiated no earlier than 30 days before action is initiated. If the patient qualifies for 100% charity care, no further bills will be sent. A letter will be sent instead indicating that the patient's bill has been completely forgiven. Part VI, Line 2: Avera Granite Falls uses many sources to assess the needs of the community, including their medical staff's daily interactions with their patients and the community. Additional sources include: federal, state, and county statistical information, public health data, internal data, and input from community members, businesses, city, and other local agencies. To gain community member input the following processes are used: interviews, focus groups, neighborhood canvassing, and surveys. Other sources have included a CHNA advisory committee that included representatives from multiple service areas in the community, including academic, governmental, non-profit, industry, and vulnerable populations. Care is taken with all information sourcing to make sure we gain the perspective of the underserved populations: Karen, Hispanic/Latino, African American, and Somali. Avera Marshall also partners with many area organizations, including Southwest Health and Human Services (SWHHS), where we share information, such as their Quality of Life survey. Part VI, Line 3: Uninsured patients who hold an inpatient status are counseled by a Patient Advocate to screen them for coverage eligibility and to assist in payer source enrollment. Those that are not eligible are provided a charity care application along with instructions on how to fill out the application. All patients receive statements that indicate who to contact should they need financial assistance. In addition, all patients receive a summary of financial assistance upon registration, as well as in their final statement. Should a patient contact Patient Financial Services and indicate inability to pay, they are transferred to a financial counselor to assist them with the financial assistance application process. Also, inpatient and same day surgery patients receive a brochure in their admissions packet. Pre-collection letters also include information regarding the financial assistance and uninsured programs. Part VI, Line 4: Avera Granite Falls is a 25-bed critical access hospital in Granite Falls, Minnesota. The primary service area is defined as Chippewa and Yellow Medicine Counties, Minnesota, including the communities of Granite Falls, Hanley Falls, Cottonwood, Wood Lake, Echo, Sacred Heart, Maynard, and Clarkfield. Granite Falls is the county seat of Yellow Medicine County. According to the U.S. Census Bureau Quick Facts 2021 data, the estimated population of Yellow Medicine County as of July 1, 2021 is 9,411 and is predominately white at 93.0%. It is estimated that 22.2% of the population is 65 years and over. The median household income is $59,289 with an 8.6% poverty rate. Uninsured individuals under age 65 is estimated at 7.9%.According to the U.S. Census Bureau Quick Facts 2021 data, the estimated population of Chippewa County as of July 1, 2021 is 12,357 and is predominately white at 92.7%. It is estimated that 21.4% of the population is 65 years and over. The median household income is $57,301 with a 9.3% poverty rate. Uninsured individuals under age 65 is estimated at 8.0%. Part VI, Line 5: Avera Granite Falls is one of the largest employers in the area and is committed to helping its community members get as much of their healthcare as close to home as possible. To this end, any surplus funds are reinvested in facilities to improve patient care, add/replace necessary equipment, and fund needed facility upgrades. For example, recent investments have been made to replace old ambulance and transport vehicles. Investments are made monthly to bring e-care services to the community so even if emergency, hospitalist, pharmacy, and long-term care specialists are not on site, they can be televised into the patient's room or local nursing/provider office. To further ensure local care, medical staff privileges are extended to all qualified physicians in the community.In addition, Avera Granite Falls is the sole provider for hospital inpatient care, the only 24/7 ER offering coverage no matter the ability to pay, birthing center, and surgery center. As a result of the mission statement, Avera Granite Falls provides numerous services which do not produce a profit. An example of this is Special Transportation Services (STS), local ambulance service, and 24/7 fully staffed emergency center. Avera Granite Falls is committed to taking care of all individuals, no matter their ability to pay. Charity care is always available for those with a diminished ability to pay. We have staff available, who meet with patients with high deductible plans and high-cost medications to find drug programs to help cover a patient's out of pocket costs. They also work with patients to complete presumptive Medicaid, full Medicare applications, answer questions on the MNSure insurance programs, help patients coordinate their insurance benefits and complete charity care applications for Avera. Avera Granite Falls pays the 1.8% MN Care Tax on gross receipts that the State of MN uses to fund the MinnesotaCare program, a state health care program for Minnesotans with low incomes. Avera Granite Falls offers a number of services that are free or low cost, including: classes such as childbirth and various other support groups, rape and sexual assault services not fully funded by the county, sharps and unused medical disposal services, transportation vouchers for patients without any options, SAGE program which insures access for female health to under and/or uninsured females, MN Vaccine for Children program to insure access to child vaccinations for all children ages 0-19 regardless of ability to pay, physicals for sports are given to students who have no means to pay but wish to participate in athletic school activities, impact testing is provided to local schools to help support concussion testing and ensure student athletes do not return before they are ready, standby ambulance at local football games, and in partnership with Big Stone Therapies, Avera provides athletic trainers to many high schools throughout the region with no cost to the school district. Avera also participates in community health events. In addition, a Chaplain and VP of Mission are employed to support patient and employee needs (work and non-work related); this includes spaces that are offered throughout the facility to support spiritual well-being, such as meditation rooms. For part of the year a drive-through COVID testing site was made available to the community. Community out-reach programs are done in partnership with local underserved communities and businesses. Avera supports the Upper Sioux Community by collaborating with initiatives like covid shots, provider CPR and First Responder Training, and EMR classes to the Upper Sioux Police. Avera Granite Falls also volunteers Ambulance hours to the Upper Sioux at their weekend long Pow Wow. In addition, virtual and other in person interpretation services are offered in several different languages. Plus, employees are being cross trained to help with medical interpretation for patients that speak Spanish, Karen, and Somali. Staff Care Coordinators are also available to help high-need patients navigate their health care needs. Educational experiences for school-aged children, students needing work study experience, and med student internships are offered, and educational classes are held for CPR. On an annual basis Avera provides scholarships for medical students and high-school students. Avera Granite Falls works closely with the Southwest Private industry Council and Minnesota West to promote early exposure to healthcare careers. In addition, Avera participates in a Reach Out and Read program which promotes early literacy for children ages 4 months to 5 years.The organization's governing body is comprised of volunteer members who reside in the community. Avera Granite Falls' leadership team, physicians, and general staff are encouraged to participate in civic and community organizations. Some of the boards and committees that employees are currently serving on include Middle Ground Haiti and Child Protection. Employees volunteer and donate in their community through programs such as United Way, Coats for Kids, stuff the bus (school supplies), and Christmas gifts for families in need. All fundraising activities go through Avera Health, a related organization. Avera also offers many opportunities for community members to volunteer within the hospital, long term care, home care, and hospice settings. Part VI, Line 6: Avera is a sponsored ministry of the Benedictine and Presentation Sisters. The communities in which Avera operates all have unique health and community benefit needs. In keeping with the Catholic Healthcare Association guidelines, each hospital strives to meet its community's identified needs. The corporate staff of Avera Health advocates for all members regarding community benefit related matters of state, regional and national importance. 0 0 0 0 0 0 0 0 0 Julie Lautt CFO Avera Health; Sec/Treas 0 1032072 0 10440 0 8716 0 14500 0 1694 0 1067422 0 0 Dr Mark Eakes - Left 122021 Director 0 309628 0 25432 0 147943 0 14500 0 31134 0 528637 0 0 Debbie Streier President/CEO 0 433517 0 10400 0 29244 0 15602 0 24725 0 513488 0 0 Mary Maertens Former President/CEO 0 366387 0 0 0 6319 0 14500 0 25338 0 412544 0 0 Tom Kooiman Director/Administrator 249096 0 0 0 2525 0 12952 0 34004 0 298577 0 0 0 Val Hoffman Former CFO 154227 0 1640 0 2045 0 8063 0 14933 0 180908 0 0 0 Shelby McNeil RN - LTC 91917 0 10783 0 3301 0 6107 0 42306 0 154414 0 0 0 Deena Aus Director - Patient Care Services 99523 0 4500 0 4722 0 6125 0 38598 0 153468 0 0 0 Jennifer Ann Jager Assistant Director - Ambulance 118241 0 9302 0 7876 0 6812 0 10535 0 152766 0 0 0 Schedule J, Part I, Line 3: The President/CEO serves Avera Marshall, Avera Tyler, and Avera Granite Falls and was compensated by a related organization, Avera Health. Avera Granite Falls relied on the related organization for determining the compensation for the President/CEO using the methods described in Part I, Line 3. Form 990, Item J: The organization's website is: avera.org/locations/avera-granite-falls-health-center/ Form 990, Part VI, Section A, line 2 Julie Lautt, Mary Maertens, Debbie Streier and Dr. Mark Eakes have a business relationship. Form 990, Part VI, Section A, line 6 The sole member of the Corporation is Avera Marshall, a nonprofit corporation organized and existing under the laws of the State of Minnesota and exempt under 501(c)(3) of the Internal Revenue Code of 1986, as amended. Form 990, Part VI, Section A, line 7a Avera Marshall as the sole member, has the power to appoint and remove, with or without cause, members of the board of directors. Form 990, Part VI, Section A, line 7b Avera Marshall, the Member of Avera Granite Falls, has the exclusive right: (a) To approve the adoption, amendment or repeal of the statements of philosophy, mission and values of the Corporation, provided that any such amendments or repeal shall be consistently applied systemwide to all similarly situated affiliates of the Member. (b) To approve the adoption, amendment or repeal of any provision of the Articles of Incorporation or Bylaws of the Corporation; provided that any such amendments impacting the composition or powers of the Board of Directors of the Corporation, including its Community Directors, shall be recommended or approved by a supermajority of the Board of Directors pursuant to Section 4.14. (c) To appoint and/or remove, with or without cause, the President and Chief Executive Officer of the Corporation. (d) To appoint and remove members of the Board of Directors of the Corporation recommended for appointment by the Governance Committee and the Board of Directors; provided that (i) the Member's exercise of its approval authority with respect to a candidate for Community Director shall be considerate of the recommendation made by the Board of Directors and may not be arbitrarily or unreasonably withheld; and (ii) an appointed Community Director may not be removed by the Member absent the Community Director's significant illegal conduct, or conduct by or status of the Community Director that causes clear jeopardy to the corporation's continuing exemption under Section 501(c)(3) of the Internal Revenue Code. (e) To appoint and/or remove, with or without cause, the Administrator of the Corporation, subject to: (i) prior mutual agreement between the Member and the Board of Directors regarding the process of selecting the Administrator; (ii) the approval by the Board of Directors of the candidate proposed by the Member for appointment to be Administrator; and (iii) consultation by the Member with the Board of Directors prior to the Member's removal of the Administrator. Notwithstanding the foregoing and any other provision of these Bylaws to the contrary, if after consulting with the Member, the Board of Directors determines to remove the Administrator, then the Member will carry out such removal following such consultation. (f) To approve operating/capital budgets and strategic plans of the Corporation following a recommendation of the Board of Directors. (g) To approve expenditures recommended by the Board of Directors outside of operating and capital budgets exceeding defined thresholds according to policy which may be adopted from time to time by the Member. (h) To approve any acquisitions, merger, consolidation, liquidation, or dissolution of the Corporation (including the plan of dissolution), sale or lease, or other transfer, or mortgage or other grant of security interest (except as pledged through Section 2.2(o) and (p)), of or in, all or substantially all of the assets of this Corporation, following a recommendation of a supermajority of the Board of Directors pursuant to Section 4.14. (i) To establish and maintain employee benefit programs. (j) To establish and maintain insurance programs. (k) To approve major community fund drives. (l) To approve the appointment of auditors. (m) To adopt policies designed to effectuate the reserved powers of the Member not inconsistent with these Bylaws. (n) To initiate and give final approval to equity and asset transfers by and between the Member and the Corporation and any affiliates or subsidiaries of the Member; provided that any such transfers in excess of $1,000,000 per year from the Corporation shall be approved by a supermajority of the Board of Directors pursuant to Section 4.14. (o) To initiate and give final approval to (i) any and all issuances of obligations under any existing or future master indentures binding the Corporation, any indebtedness (including, without limitation, capitalized leases) in excess of dollar thresholds as may be from time to time established by the Member, and (ii) any pledges of collateral for such indebtedness and any pledges of real estate as collateral for any indebtedness regardless of amount. (p) Full and exclusive power to: (i) execute supplemental master indentures, including, without limitation, those authorizing the issuance of obligations or series of obligations, (ii) full and exclusive power to prepare, or authorize the preparation of, any and all documents, agreements, swap agreements, investment contracts, certificates and disclosure materials (including, without limitation, Official Statements and any supplements thereto) reasonably and ordinarily prepared in connection with the issuance of obligations thereunder, or related bonds associated therewith and to execute and deliver such items to the appropriate parties in connection therewith, and (iii) full and exclusive power to authorize the entrance of members to, or withdrawal of members from, any obligated group, subject to the other requirements of the applicable master indenture for such entrance or withdrawal. Form 990, Part VI, Section A, line 8b There are no committees with the authority to act on behalf of the governing body. Form 990, Part VI, Section B, line 11b The Form 990 is reviewed by the Avera Health VP of Financial Reporting, Tax Manager, Facility CEO and Finance Committee (if applicable). After initial review the Form 990 is made available to the Board and other Operation Finance Leaders. Form 990, Part VI, Section B, line 12c The conflict of interest policy covers board members, officers and key employees. At each board meeting, a request is made for all board members to disclose any potential conflict of interest pertaining to any item listed on the agenda or pertaining to any potential item that could be discussed during the course of the meeting. The declaration of conflict of interest is recorded in the meeting minutes. The board makes a determination of whether there is a conflict of interest and if so, implements the procedure for evaluating the issue or transaction involved. The board member or officer with the conflict must refrain from voting. A statement of conflict of interest disclosure is made on an annual basis by officers and directors. The information is maintained in a database and a report is provided to the board. Form 990, Part VI, Section B, line 15 The CEO and CFO-Avera Health are compensated by Avera Health. Annually the Compensation Committee of Avera Health, which is comprised of six (6) System Members appointed by the Religious Orders, meets with an independent consultant regarding fair market value of officers and key employees. The Compensation Committee approves all salaries based on comparable data and documents the basis for their decision in meeting minutes. Depending on the individual's role with the organization, some officers are compensated by Avera Granite Falls. Form 990, Part VI, Section C, line 19 The organization's governing documents and conflict of interest policy are not made available to the general public. The Organization's financial statements are attached to the Form 990 per IRS instructions and therefore available to the general public. Form 990, Part IX, line 11g Purchased Services: Program service expenses 3,693,070. Management and general expenses 20,712. Fundraising expenses 0. Total expenses 3,713,782. Medical Prof Fees: Program service expenses 51,517. Management and general expenses 0. Fundraising expenses 0. Total expenses 51,517. Repairs and Maintenance: Program service expenses 518,284. Management and general expenses 236,567. Fundraising expenses 0. Total expenses 754,851. Centralized Services: Program service expenses 624,324. Management and general expenses 1,519,752. Fundraising expenses 0. Total expenses 2,144,076. Form 990, Part XI, line 9: Change in Interest in Avera Foundation -244,184. Form 990, Part XII, Line 2c: The Audit Committee of Avera Health, parent organization, selects the auditor and reviews the consolidated audited financial statements for Avera Health, which includes Avera Granite Falls. Form 990, Part X, Line 20: Avera Granite Falls is part of the Avera Obligated Group which 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. Avera Granite Falls was not allocated any share of the bond issue, and thus does not have an amount on line 20. Avera Health 3900 West Avera Drive Suite 101 Sioux Falls SD 57108 460422673 Healthcare services SD 501(c)(3) Line 10 N/A 0 Avera Holy Family 826 North 8th Street Estherville IA 51334 420680370 Healthcare services IA 501(c)(3) Line 3 Avera Health 0 Holy Family Hospital Foundation 826 North 8th Street Estherville IA 51334 421317452 Support health related services IA 501(c)(3) Line 10 Avera Holy Family 0 St Benedict Health Center 401 West Glynn Drive Parkston SD 57366 460226738 Healthcare services SD 501(c)(3) Line 3 Avera Health 0 St Benedict Health Center Foundation West Glynn Drive PO Box B Parkston SD 57366 460458725 Support health related services SD 501(c)(3) Line 12a, I St Benedict Health Center 0 Avera McKennan 1325 S Cliff Ave PO Box 5045 Sioux Falls SD 57117 460224743 Healthcare services SD 501(c)(3) Line 3 Avera Health 0 Avera Queen of Peace Hospital 525 North Foster Mitchell SD 57301 460224604 Healthcare services SD 501(c)(3) Line 3 Avera Health 0 Sacred Heart Health Services 501 Summit Street Yankton SD 57078 460225483 Healthcare services SD 501(c)(3) Line 3 Avera Health 0 Avera Gettysburg 606 East Garfield Gettysburg SD 57442 460234354 Healthcare services SD 501(c)(3) Line 3 Avera St Mary's 0 Avera at Home 5116 S Solberg Ave Sioux Falls SD 57108 460399291 Home services SD 501(c)(3) Line 10 Avera Health 0 Lewis and Clark Health Education and Service Agency 1000 W 4th Street Suite 9 Yankton SD 57078 460337013 Healthcare services SD 501(c)(3) Line 10 Sacred Heart Health Services 0 Avera St Luke's 305 South State Street Aberdeen SD 57401 460224598 Healthcare services SD 501(c)(3) Line 3 Avera Health 0 Avera St Mary's 801 East Sioux Avenue Pierre SD 57501 460230199 Healthcare services SD 501(c)(3) Line 3 Avera Health 0 Avera Marshall 300 S Bruce Street Marshall MN 56258 410919153 Healthcare services MN 501(c)(3) Line 3 Avera Health 0 Avera Tyler 240 Willow Street Tyler MN 56178 410853163 Healthcare services MN 501(c)(3) Line 3 Avera Marshall 0 Avera Health Plans Inc 3900 West Avera Drive Suite 101 Sioux Falls SD 57108 460451539 Health financing & health plan admin SD 501(c)(4) Avera Health 1 Avera St Anthony's Hospital 300 N 2nd Street ONeill NE 68763 470463911 Healthcare services NE 501(c)(3) Line 3 Avera Health 0 Avera Home Medical Equipment of Floyd Valley Hospital LLC 714 Lincoln St NE Lemars IA 51031 820582350 Medical services - home medical equipment SD N/A 0 0 Avera Home Medical Equipment of Sioux Center LLC 38 19th St SW Sioux Center IA 51250 753203100 Medical services - home medical equipment SD N/A 0 0 Surgical Associates Endoscopy Clinic LLC 310 S Penn Aberdeen SD 57401 460461429 Surgical associates SD N/A 0 0 Avera Home Medical Equipment of Spencer Hospital LLC 2400 S Minnesota Ave Sioux Falls SD 57117 800619999 Medical Services - home medical equipment SD N/A 0 0 Heart Hospital of South Dakota LLC 4500 W 69th Street Sioux Falls SD 57108 562143771 Healthcare Services SD N/A 0 0 Brookings Health System - Avera HME LLC 101 22nd Ave Suite 101 Brookings SD 57006 453204123 Healthcare Services SD N/A 0 0 Caravan Health ACO 41 LLC dba Prairie View Care Organization 7509 NW Tiffany Springs Parkway Kansas City MO 64153 821447782 Accountable Care Organization MO N/A 0 0 Caravan Health ACO 15 LLC dba Prairie Vista Care Organization 7509 NW Tiffany Springs Parkway Ste Kansas City MO 64153 611843657 Accountable Care Organization MO N/A 0 0 Avera Home Medical Equipment of Lakes Regional Healthcare LLC 2301 Hwy 71 South Ste D Spirit Lake IA 51360 862949748 Medical services - home medical equipment IA N/A 0 0 Accounts Management Inc 5132 S Cliff Ave Suite 101 Sioux Falls SD 57108 460373021 Collection agency SD N/A C 0 Avera Property Insurance Inc 1000 West 4th Street Suite 1 Yankton SD 57078 460463155 Insurance SD N/A C 0 Valley Health Services 501 Summit Street Yankton SD 57078 460357149 Rental real estate SD N/A C 0 Alucent Biomedical Inc 1325 S Cliff Avenue PO Box 5045 Sioux Falls SD 571175045 471818349 Biotech Research SD N/A C 0 South Dakota State Medical Holding Company Inc 5300 South Broadband Lane Sioux Falls SD 57108 460401087 Insurance SD N/A C 0 DakotaCare Administrative Services Inc 5300 South Broadband Lane Sioux Falls SD 57108 460424322 Insurance SD N/A C 0 Alucent Australia Pty Ltd Level 10 30 Collings Street Melbourne VIC 3000 AS Biotech Research AS N/A 0 0 0 0 0 1 0 0 0 0 1 1 0 1 1 1 1 1 1 1