AVERA MARSHALL: Form 990, tax year 2019

View the entire original 990 at ProPublica ↗

Organization: AVERA MARSHALL (EIN 41-0919153)
Tax period: 2019-07-01 to 2020-06-30
Filed: 2021-05-17
IRS object ID: 202141379349304849
Schema version: 2019v5.2
Source: Download XML · Original 990 at ProPublica

Every field in the e-filed return. Faint text is the IRS element name, for citing.

Return header
Form 990
Schedule A
Schedule B
Schedule C
Schedule D
Schedule H
Schedule I
Schedule J
Schedule O
Schedule R

Return header ReturnHeader

Field	Value	IRS element (for citing)
Return	2021-05-17T13:17:02-05:00	ReturnTs
Tax Period End	2020-06-30	TaxPeriodEndDt

Preparer Firm PreparerFirmGrp

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

Preparer Firm Name PreparerFirmName

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

Preparer US Address PreparerUSAddress

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

Field	Value	IRS element (for citing)
Return Type	990	ReturnTypeCd
Tax Period Begin	2019-07-01	TaxPeriodBeginDt

Filer Filer

Field	Value	IRS element (for citing)
EIN	410919153	EIN

Business Name BusinessName

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

Field	Value	IRS element (for citing)
Business Name Control	AVER	BusinessNameControlTxt
Phone	5075329661	PhoneNum

US Address USAddress

Field	Value	IRS element (for citing)
Address Line1	300 S Bruce Street	AddressLine1Txt
City	Marshall	CityNm
State Abbreviation	MN	StateAbbreviationCd
ZIP	562581934	ZIPCd

Business Officer BusinessOfficerGrp

Field	Value	IRS element (for citing)
Person	Julie Lautt	PersonNm
Person Title	CFO Avera Health	PersonTitleTxt
Phone	5075329661	PhoneNum
Signature	2021-05-11	SignatureDt
Discuss With Paid Preparer	Yes (1)	DiscussWithPaidPreparerInd

Preparer Person PreparerPersonGrp

Field	Value	IRS element (for citing)
Preparer Person	Kim Hunwardsen CPA	PreparerPersonNm
PTIN	P00484560	PTIN
Phone	6122536500	PhoneNum
Preparation	2021-05-11	PreparationDt

Field	Value	IRS element (for citing)
Tax	2019	TaxYr
Build TS	2022-09-23 18:48:47Z	BuildTS

Form 990 IRS990

Doing Business As Name DoingBusinessAsName

Field	Value	IRS element (for citing)
Business Name Line1	Avera Marshall Regional Medical Center	BusinessNameLine1Txt

Field	Value	IRS element (for citing)
Principal Officer	Debbie Streier	PrincipalOfficerNm

US Address USAddress

Field	Value	IRS element (for citing)
Address Line1	300 S Bruce Street	AddressLine1Txt
City	Marshall	CityNm
State Abbreviation	MN	StateAbbreviationCd
ZIP	562581934	ZIPCd

Field	Value	IRS element (for citing)
Gross Receipts	$115,308,262	GrossReceiptsAmt
Group Return For Affiliates	0	GroupReturnForAffiliatesInd
Organization501c3	Yes (X)	Organization501c3Ind
Website Address	www.avera.org	WebsiteAddressTxt
Type Of Organization Corp	Yes (X)	TypeOfOrganizationCorpInd
Formation	1944	FormationYr
Legal Domicile State	MN	LegalDomicileStateCd
Activity Or Mission	Promotion of health	ActivityOrMissionDesc
Voting Members Governing Body	13	VotingMembersGoverningBodyCnt
Voting Members Independent	10	VotingMembersIndependentCnt
Total Employee	880	TotalEmployeeCnt
Total Volunteers	137	TotalVolunteersCnt
Total Gross UBI	$34,153	TotalGrossUBIAmt
Net Unrelated Bus Txbl Incm	$20,689	NetUnrelatedBusTxblIncmAmt
PY Contributions Grants	$279,101	PYContributionsGrantsAmt
CY Contributions Grants	$6,251,034	CYContributionsGrantsAmt
PY Program Service Revenue	$96,686,666	PYProgramServiceRevenueAmt
CY Program Service Revenue	$108,617,104	CYProgramServiceRevenueAmt
PY Investment Income	$965,081	PYInvestmentIncomeAmt
CY Investment Income	$123,444	CYInvestmentIncomeAmt
PY Other Revenue	$93,441	PYOtherRevenueAmt
CY Other Revenue	$164,663	CYOtherRevenueAmt
PY Total Revenue	$98,024,289	PYTotalRevenueAmt
CY Total Revenue	$115,156,245	CYTotalRevenueAmt
PY Grants And Similar Paid	$25,000	PYGrantsAndSimilarPaidAmt
CY Grants And Similar Paid	$53,000	CYGrantsAndSimilarPaidAmt
PY Benefits Paid To Members	$0	PYBenefitsPaidToMembersAmt
CY Benefits Paid To Members	$0	CYBenefitsPaidToMembersAmt
PY Salaries Comp Emp Bnft Paid	$57,506,424	PYSalariesCompEmpBnftPaidAmt
CY Salaries Comp Emp Bnft Paid	$59,184,087	CYSalariesCompEmpBnftPaidAmt
PY Total Prof Fndrsng Expns	$0	PYTotalProfFndrsngExpnsAmt
CY Total Prof Fndrsng Expns	$0	CYTotalProfFndrsngExpnsAmt
CY Total Fundraising Expense	$136,298	CYTotalFundraisingExpenseAmt
PY Other Expenses	$47,208,159	PYOtherExpensesAmt
CY Other Expenses	$71,928,783	CYOtherExpensesAmt
PY Total Expenses	$104,739,583	PYTotalExpensesAmt
CY Total Expenses	$131,165,870	CYTotalExpensesAmt
PY Revenues Less Expenses	-$6,715,294	PYRevenuesLessExpensesAmt
CY Revenues Less Expenses	-$16,009,625	CYRevenuesLessExpensesAmt
Total Assets BOY	$107,934,459	TotalAssetsBOYAmt
Total Assets EOY	$102,725,540	TotalAssetsEOYAmt
Total Liabilities BOY	$43,604,084	TotalLiabilitiesBOYAmt
Total Liabilities EOY	$54,380,753	TotalLiabilitiesEOYAmt
Net Assets Or Fund Balances BOY	$64,330,375	NetAssetsOrFundBalancesBOYAmt
Net Assets Or Fund Balances EOY	$48,344,787	NetAssetsOrFundBalancesEOYAmt
Info In Schedule O Part III	Yes (X)	InfoInScheduleOPartIIIInd
Mission	Avera is a health ministry rooted in the gospel. Our mission is to make a positive impact in the lives and health of persons and communities by providing quality services guided by Christian values.	MissionDesc
Significant New Program Srvc	0	SignificantNewProgramSrvcInd
Significant Change	0	SignificantChangeInd
Expense	$113,786,583	ExpenseAmt
Grant	$53,000	GrantAmt
Revenue	$108,676,072	RevenueAmt
Desc	Avera Marshall's mission is to provide healthcare services to Marshall, Minnesota residents and residents of the surrounding area. Avera Marshall is a 501(c)(3) organization affiliated with Avera Health. Avera Marshall consists of a 25-bed critical access hospital and a 76-bed nursing home in Marshall, Minnesota, seven physician clinics and four optometry clinics. The program services offered include primary care, general surgery, neurology, dermatology, pediatrics, orthopedics, OG/GYN, urology, oncology, podiatry, nephrology, radiology, optometry, ophthalmology, level III trauma center, ICU, speech therapy, physical therapy and occupational therapy. Avera Marshall provides acute care and long-term healthcare services. Following is a breakdown of these statistics by facility:Avera Marshall Hospital1,779 Acute patient discharges440 Newborn patient discharges16 Swing bed patient discharges46,753 Outpatient visits74 Swing-bed patient days717 Newborn patient days117,260 Clinic visitsAvera Morningside Heights Care Center27,067 Long-term resident days120 Long Term Care patient dischargesAvera Marshall 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 $1,305,780.Avera Marshall 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 Marshall 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 Marshall engages in activities designed to improve the health of individuals and communities in response to a calling to heal the sick, the elderly, and the oppressed.	Desc
Total Program Service Expenses	$113,786,583	TotalProgramServiceExpensesAmt
Described In Section501c3	Yes (1)	DescribedInSection501c3Ind
Schedule B Required	Yes (1)	ScheduleBRequiredInd
Political Campaign Acty	0	PoliticalCampaignActyInd
Lobbying Activities	Yes (1)	LobbyingActivitiesInd
Subject To Proxy Tax	0	SubjectToProxyTaxInd
Donor Advised Fund	0	DonorAdvisedFundInd
Conservation Easements	0	ConservationEasementsInd
Collections Of Art	0	CollectionsOfArtInd
Credit Counseling	Yes (1)	CreditCounselingInd
Donor Rstr Or Quasi Endowments	0	DonorRstrOrQuasiEndowmentsInd
Report Land Building Equipment	Yes (1)	ReportLandBuildingEquipmentInd
Report Investments Other Sec	Yes (1)	ReportInvestmentsOtherSecInd
Report Program Related Invst	0	ReportProgramRelatedInvstInd
Report Other Assets	Yes (1)	ReportOtherAssetsInd
Report Other Liabilities	Yes (1)	ReportOtherLiabilitiesInd
Include FIN48 Footnote	Yes (1)	IncludeFIN48FootnoteInd
Independent Audit Fincl Stmt	0	IndependentAuditFinclStmtInd
Consolidated Audit Fincl Stmt	Yes (1)	ConsolidatedAuditFinclStmtInd
School Operating	0	SchoolOperatingInd
Foreign Office	0	ForeignOfficeInd
Foreign Activities	0	ForeignActivitiesInd
More Than5000 K To Org	0	MoreThan5000KToOrgInd
More Than5000 K To Individuals	0	MoreThan5000KToIndividualsInd
Professional Fundraising	0	ProfessionalFundraisingInd
Fundraising Activities	0	FundraisingActivitiesInd
Gaming Activities	0	GamingActivitiesInd
Operate Hospital	Yes (1)	OperateHospitalInd
Audited Financial Stmt Att	Yes (1)	AuditedFinancialStmtAttInd
Grants To Organizations	Yes (1)	GrantsToOrganizationsInd
Grants To Individuals	0	GrantsToIndividualsInd
Schedule J Required	Yes (1)	ScheduleJRequiredInd
Tax Exempt Bonds	0	TaxExemptBondsInd
Engaged In Excess Benefit Trans	0	EngagedInExcessBenefitTransInd
PY Excess Benefit Trans	0	PYExcessBenefitTransInd
Loan Outstanding	0	LoanOutstandingInd
Grant To Related Person	0	GrantToRelatedPersonInd
Business Rln With Org Mem	0	BusinessRlnWithOrgMemInd
Business Rln With Fam Mem	0	BusinessRlnWithFamMemInd
Business Rln With35 Ctrl Ent	0	BusinessRlnWith35CtrlEntInd
Deductible Non Cash Contri	0	DeductibleNonCashContriInd
Deductible Art Contribution	0	DeductibleArtContributionInd
Terminate Operations	0	TerminateOperationsInd
Partial Liquidation	0	PartialLiquidationInd
Disregarded Entity	0	DisregardedEntityInd
Related Entity	Yes (1)	RelatedEntityInd
Related Organization Ctrl Ent	Yes (1)	RelatedOrganizationCtrlEntInd
Transaction With Control Ent	0	TransactionWithControlEntInd
Trnsfr Exmpt Non Chrtbl Rltd Org	0	TrnsfrExmptNonChrtblRltdOrgInd
Activities Conducted Prtshp	0	ActivitiesConductedPrtshpInd
Schedule O Required	Yes (1)	ScheduleORequiredInd
IRP Document	125	IRPDocumentCnt
IRP Document W2 G	0	IRPDocumentW2GCnt
Backup Wthld Compliance	Yes (1)	BackupWthldComplianceInd
Employee	880	EmployeeCnt
Employment Tax Returns Filed	Yes (1)	EmploymentTaxReturnsFiledInd
Unrelated Bus Incm Over Limit	Yes (1)	UnrelatedBusIncmOverLimitInd
Form990 T Filed	Yes (1)	Form990TFiledInd
Foreign Financial Account	0	ForeignFinancialAccountInd
Prohibited Tax Shelter Trans	0	ProhibitedTaxShelterTransInd
Taxable Party Notification	0	TaxablePartyNotificationInd
Nondeductible Contributions	0	NondeductibleContributionsInd
Quid Pro Quo Contributions	0	QuidProQuoContributionsInd
Form8282 Property Disposed Of	0	Form8282PropertyDisposedOfInd
Rcv Fnds To Pay Prsnl Bnft Cntrct	0	RcvFndsToPayPrsnlBnftCntrctInd
Pay Premiums Prsnl Bnft Cntrct	0	PayPremiumsPrsnlBnftCntrctInd
Indoor Tanning Services	0	IndoorTanningServicesInd
Subj To Tax Rmnrtn Ex Prcht Pymt	0	SubjToTaxRmnrtnExPrchtPymtInd
Subject To Excs Tax Net Invst Inc	0	SubjectToExcsTaxNetInvstIncInd
Info In Schedule O Part VI	Yes (X)	InfoInScheduleOPartVIInd
Governing Body Voting Members	13	GoverningBodyVotingMembersCnt
Independent Voting Member	10	IndependentVotingMemberCnt
Family Or Business Rln	Yes (1)	FamilyOrBusinessRlnInd
Delegation Of Mgmt Duties	0	DelegationOfMgmtDutiesInd
Change To Org Documents	0	ChangeToOrgDocumentsInd
Material Diversion Or Misuse	0	MaterialDiversionOrMisuseInd
Members Or Stockholders	Yes (1)	MembersOrStockholdersInd
Election Of Board Members	Yes (1)	ElectionOfBoardMembersInd
Decisions Subject To Approva	Yes (1)	DecisionsSubjectToApprovaInd
Minutes Of Governing Body	Yes (1)	MinutesOfGoverningBodyInd
Minutes Of Committees	Yes (1)	MinutesOfCommitteesInd
Officer Mailing Address	0	OfficerMailingAddressInd
Local Chapters	0	LocalChaptersInd
Form990 Provided To Gvrn Body	Yes (1)	Form990ProvidedToGvrnBodyInd
Conflict Of Interest Policy	Yes (1)	ConflictOfInterestPolicyInd
Annual Disclosure Covered Prsn	Yes (1)	AnnualDisclosureCoveredPrsnInd
Regular Monitoring Enfrc	Yes (1)	RegularMonitoringEnfrcInd
Whistleblower Policy	Yes (1)	WhistleblowerPolicyInd
Document Retention Policy	Yes (1)	DocumentRetentionPolicyInd
Compensation Process CEO	0	CompensationProcessCEOInd
Compensation Process Other	Yes (1)	CompensationProcessOtherInd
Investment In Joint Venture	Yes (1)	InvestmentInJointVentureInd
Written Policy Or Procedure	0	WrittenPolicyOrProcedureInd
States Where Copy Of Return Is Fld	MN	StatesWhereCopyOfReturnIsFldCd
Upon Request	Yes (X)	UponRequestInd

Books In Care Of Detail BooksInCareOfDetail

Business Name BusinessName

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

Field	Value	IRS element (for citing)
Phone	6053223992	PhoneNum

US Address USAddress

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

Form990 Part VII Section A Form990PartVIISectionAGrp (22 entries)

TitleTitleTxt	Average Hours Per WeekAverageHoursPerWeekRt	Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt	Highest Compensated EmployeeHighestCompensatedEmployeeInd	Reportable Comp From OrgReportableCompFromOrgAmt	Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt	Other CompensationOtherCompensationAmt	OfficerOfficerInd	Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd	Former Ofcr Director TrusteeFormerOfcrDirectorTrusteeInd	Key EmployeeKeyEmployeeInd
Vikram Chatrath MD
Orthopedics & Surgery	40.00	0.00	Yes (X)	$1,082,870	$0	$53,495
Jim Breckenridge - Left 42020
CFO Avera Health; Sec/Treasurer	0.10	41.30		$0	$1,018,166	$36,856	Yes (X)
Curtis Louwagie MD
Director/Ophthalmologist	41.30	1.30		$759,380	$0	$48,258		Yes (X)
Alain Desy MD
Orthopedics & Surgery	40.00	0.00	Yes (X)	$658,578	$0	$46,495
Julie Lautt - Joined 42020
CFO Avera Health; Sec/Treasurer	0.10	40.70		$0	$518,454	$35,583	Yes (X)
Trent Carlson
General Surgery	40.00	0.00	Yes (X)	$489,621	$0	$35,440
Maggie Jane Steinbeisser
General Surgery	40.00	0.00	Yes (X)	$478,250	$0	$43,954
Miranda Renfrow DO
Ophthalmology	40.00	0.00	Yes (X)	$485,967	$0	$20,447
Mary B Maertens
President & CEO	41.30	2.30		$0	$452,406	$41,358	Yes (X)	Yes (X)
Sharon WilliamsFormer
Sec/Treas & VP Finance	0.00	40.00		$0	$182,151	$34,817			Yes (X)
Doris Derynck
VP Clinical Operations/CNO	40.00	1.00		$179,877	$0	$32,481				Yes (X)
Joyce Strootman
Chair	1.30	1.30		$0	$0	$0	Yes (X)	Yes (X)
Doug Olsem
Vice Chair	1.30	1.30		$0	$0	$0	Yes (X)	Yes (X)
Stephen Crim
Director	1.30	1.30		$0	$17,395	$0		Yes (X)
Sr Jodie Zimmerman
Director	1.30	1.30		$0	$0	$0		Yes (X)
Sr Roxanne Seifert
Director	1.30	1.30		$0	$0	$0		Yes (X)
Todd Bock
Director	1.30	1.30		$0	$0	$0		Yes (X)
Amanda Sieling
Director	1.30	1.30		$0	$0	$0		Yes (X)
Randy Serreyn
Director	1.30	1.30		$0	$0	$0		Yes (X)
Quentin Fixen
Director	1.30	1.30		$0	$0	$0		Yes (X)
Laurie Johansen
Director	1.30	1.30		$0	$0	$0		Yes (X)
George Jorgensen
Director	1.30	2.30		$0	$0	$0		Yes (X)

Field	Value	IRS element (for citing)
Total Reportable Comp From Org	$4,134,543	TotalReportableCompFromOrgAmt
Tot Reportable Comp Rltd Org	$2,188,572	TotReportableCompRltdOrgAmt
Total Other Compensation	$429,184	TotalOtherCompensationAmt
Indiv Rcvd Greater Than100 K	100	IndivRcvdGreaterThan100KCnt
Former Ofcr Employees Listed	Yes (1)	FormerOfcrEmployeesListedInd
Total Comp Greater Than150 K	Yes (1)	TotalCompGreaterThan150KInd
Compensation From Other Srcs	0	CompensationFromOtherSrcsInd

Contractor Compensation ContractorCompensationGrp (5 entries)

Address Line1ContractorAddress/USAddress/AddressLine1Txt	CityContractorAddress/USAddress/CityNm	State AbbreviationContractorAddress/USAddress/StateAbbreviationCd	ZIPContractorAddress/USAddress/ZIPCd	ServicesServicesDesc	CompensationCompensationAmt
Avera Health
3900 W Avera Dr Ste 301	Sioux Falls	SD	57108	Shared services	$10,035,702
Carris Health
301 Becker Ave SW	Willmar	MN	56201	Physician/Shared Services	$6,727,112
Big Stone Therapies Inc
500 Cross St	Big Stone City	SD	571175045	PT, OT, and Speech Therapy	$4,331,160
Avera McKennan
1325 S Cliff Ave	Sioux Falls	SD	57117	Physicians and Anciliary	$2,701,324
Journey Group Companies
4500 W 58th Street	Sioux Falls	SD	57108	Construction Services	$2,302,698

Field	Value	IRS element (for citing)
Cntrct Rcvd Greater Than100 K	24	CntrctRcvdGreaterThan100KCnt
Related Organizations	$206,480	RelatedOrganizationsAmt
Government Grants	$6,044,554	GovernmentGrantsAmt
Noncash Contributions	$12,135	NoncashContributionsAmt
Total Contributions	$6,251,034	TotalContributionsAmt

Program Service Revenue ProgramServiceRevenueGrp (4 entries)

DescDesc	BusinessBusinessCd	Total Revenue ColumnTotalRevenueColumnAmt	Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt
Net Patient Service Revenue	622110	$106,933,038	$106,933,038
Pharmacy Revenue	900099	$907,437	$907,437
Cafeteria Revenue	900099	$254,694	$254,694
Partnership Revenue/Loss	900099	-$183,471	-$183,471

Total Oth Program Service Rev TotalOthProgramServiceRevGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$705,406	TotalRevenueColumnAmt
Related Or Exempt Func Income	$671,253	RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue	$34,153	UnrelatedBusinessRevenueAmt

Field	Value	IRS element (for citing)
Total Program Service Revenue	$108,617,104	TotalProgramServiceRevenueAmt

Gross Rents GrossRentsGrp

Field	Value	IRS element (for citing)
Real	$84,714	RealAmt

Less Rental Expenses LessRentalExpensesGrp

Field	Value	IRS element (for citing)
Real	$13,172	RealAmt

Rental Income Or Loss RentalIncomeOrLossGrp

Field	Value	IRS element (for citing)
Real	$71,542	RealAmt

Net Rental Income Or Loss NetRentalIncomeOrLossGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$71,542	TotalRevenueColumnAmt
Exclusion	$71,542	ExclusionAmt

Gross Amount Sales Assets GrossAmountSalesAssetsGrp

Field	Value	IRS element (for citing)
Securities	$212,289	SecuritiesAmt
Other	$50,000	OtherAmt

Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp

Field	Value	IRS element (for citing)
Securities	$0	SecuritiesAmt
Other	$138,845	OtherAmt

Gain Or Loss GainOrLossGrp

Field	Value	IRS element (for citing)
Securities	$212,289	SecuritiesAmt
Other	-$88,845	OtherAmt

Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$123,444	TotalRevenueColumnAmt
Exclusion	$123,444	ExclusionAmt

Other Revenue Misc OtherRevenueMiscGrp

Field	Value	IRS element (for citing)
Desc	Operating interest	Desc
Business	900099	BusinessCd
Total Revenue Column	$93,121	TotalRevenueColumnAmt
Related Or Exempt Func Income	$93,121	RelatedOrExemptFuncIncomeAmt

Field	Value	IRS element (for citing)
Other Revenue Total	$93,121	OtherRevenueTotalAmt

Total Revenue TotalRevenueGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$115,156,245	TotalRevenueColumnAmt
Related Or Exempt Func Income	$108,676,072	RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue	$34,153	UnrelatedBusinessRevenueAmt
Exclusion	$194,986	ExclusionAmt

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

Grants To Domestic Orgs GrantsToDomesticOrgsGrp

Field	Value	IRS element (for citing)
Total	$48,000	TotalAmt
Program Services	$48,000	ProgramServicesAmt

Grants To Domestic Individuals GrantsToDomesticIndividualsGrp

Field	Value	IRS element (for citing)
Total	$5,000	TotalAmt
Program Services	$5,000	ProgramServicesAmt

Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp

Field	Value	IRS element (for citing)
Total	$1,005,295	TotalAmt
Program Services	$787,700	ProgramServicesAmt
Management And General	$217,595	ManagementAndGeneralAmt

Comp Disqual Persons CompDisqualPersonsGrp

Field	Value	IRS element (for citing)
Total	$207,759	TotalAmt
Management And General	$207,759	ManagementAndGeneralAmt

Other Salaries And Wages OtherSalariesAndWagesGrp

Field	Value	IRS element (for citing)
Total	$46,110,188	TotalAmt
Program Services	$45,359,271	ProgramServicesAmt
Management And General	$668,729	ManagementAndGeneralAmt
Fundraising	$82,188	FundraisingAmt

Pension Plan Contributions PensionPlanContributionsGrp

Field	Value	IRS element (for citing)
Total	$2,196,719	TotalAmt
Program Services	$2,140,468	ProgramServicesAmt
Management And General	$53,624	ManagementAndGeneralAmt
Fundraising	$2,627	FundraisingAmt

Other Employee Benefits OtherEmployeeBenefitsGrp

Field	Value	IRS element (for citing)
Total	$6,700,142	TotalAmt
Program Services	$6,485,647	ProgramServicesAmt
Management And General	$191,271	ManagementAndGeneralAmt
Fundraising	$23,224	FundraisingAmt

Payroll Taxes PayrollTaxesGrp

Field	Value	IRS element (for citing)
Total	$2,963,984	TotalAmt
Program Services	$2,872,322	ProgramServicesAmt
Management And General	$84,919	ManagementAndGeneralAmt
Fundraising	$6,743	FundraisingAmt

Fees For Services Legal FeesForServicesLegalGrp

Field	Value	IRS element (for citing)
Total	$319,477	TotalAmt
Management And General	$319,477	ManagementAndGeneralAmt

Fees For Services Accounting FeesForServicesAccountingGrp

Field	Value	IRS element (for citing)
Total	$5,250	TotalAmt
Program Services	$5,250	ProgramServicesAmt

Fees For Services Lobbying FeesForServicesLobbyingGrp

Field	Value	IRS element (for citing)
Total	$739	TotalAmt
Management And General	$739	ManagementAndGeneralAmt

Fees For Services Other FeesForServicesOtherGrp

Field	Value	IRS element (for citing)
Total	$32,976,582	TotalAmt
Program Services	$21,253,829	ProgramServicesAmt
Management And General	$11,707,303	ManagementAndGeneralAmt
Fundraising	$15,450	FundraisingAmt

Advertising AdvertisingGrp

Field	Value	IRS element (for citing)
Total	$1,079	TotalAmt
Program Services	$118	ProgramServicesAmt
Management And General	$961	ManagementAndGeneralAmt

Office Expenses OfficeExpensesGrp

Field	Value	IRS element (for citing)
Total	$923,393	TotalAmt
Program Services	$563,793	ProgramServicesAmt
Management And General	$357,581	ManagementAndGeneralAmt
Fundraising	$2,019	FundraisingAmt

Information Technology InformationTechnologyGrp

Field	Value	IRS element (for citing)
Total	$719,159	TotalAmt
Program Services	$84,943	ProgramServicesAmt
Management And General	$634,216	ManagementAndGeneralAmt

Occupancy OccupancyGrp

Field	Value	IRS element (for citing)
Total	$1,961,482	TotalAmt
Program Services	$1,658,241	ProgramServicesAmt
Management And General	$303,241	ManagementAndGeneralAmt

Travel TravelGrp

Field	Value	IRS element (for citing)
Total	$487,313	TotalAmt
Program Services	$462,519	ProgramServicesAmt
Management And General	$22,426	ManagementAndGeneralAmt
Fundraising	$2,368	FundraisingAmt

Conferences Meetings ConferencesMeetingsGrp

Field	Value	IRS element (for citing)
Total	$269,574	TotalAmt
Program Services	$268,111	ProgramServicesAmt
Management And General	$1,463	ManagementAndGeneralAmt

Interest InterestGrp

Field	Value	IRS element (for citing)
Total	$1,166,898	TotalAmt
Program Services	$1,077,284	ProgramServicesAmt
Management And General	$89,614	ManagementAndGeneralAmt

Depreciation Depletion DepreciationDepletionGrp

Field	Value	IRS element (for citing)
Total	$5,988,269	TotalAmt
Program Services	$5,450,916	ProgramServicesAmt
Management And General	$536,892	ManagementAndGeneralAmt
Fundraising	$461	FundraisingAmt

Insurance InsuranceGrp

Field	Value	IRS element (for citing)
Total	$328,379	TotalAmt
Program Services	$323,174	ProgramServicesAmt
Management And General	$5,205	ManagementAndGeneralAmt

Other Expenses OtherExpensesGrp (4 entries)

DescDesc	TotalTotalAmt	Program ServicesProgramServicesAmt	Management And GeneralManagementAndGeneralAmt	FundraisingFundraisingAmt
Medical Supplies	$20,539,794	$20,475,198	$64,477	$119
Equipment Lease/Rental	$211,001	$210,841	$160
Bad Debt	$29,953	$29,953
Provision for income ta	$3,500	$3,500

All Other Expenses AllOtherExpensesGrp

Field	Value	IRS element (for citing)
Total	$5,996,941	TotalAmt
Program Services	$4,220,505	ProgramServicesAmt
Management And General	$1,775,337	ManagementAndGeneralAmt
Fundraising	$1,099	FundraisingAmt

Total Functional Expenses TotalFunctionalExpensesGrp

Field	Value	IRS element (for citing)
Total	$131,165,870	TotalAmt
Program Services	$113,786,583	ProgramServicesAmt
Management And General	$17,242,989	ManagementAndGeneralAmt
Fundraising	$136,298	FundraisingAmt

Savings And Temp Cash Invst SavingsAndTempCashInvstGrp

Field	Value	IRS element (for citing)
BOY	$2,083,312	BOYAmt
EOY	$1,277,978	EOYAmt

Pledges And Grants Receivable PledgesAndGrantsReceivableGrp

Field	Value	IRS element (for citing)
BOY	$5,857	BOYAmt
EOY	$15,816	EOYAmt

Accounts Receivable AccountsReceivableGrp

Field	Value	IRS element (for citing)
BOY	$15,362,271	BOYAmt
EOY	$13,014,061	EOYAmt

Inventories For Sale Or Use InventoriesForSaleOrUseGrp

Field	Value	IRS element (for citing)
BOY	$2,789,911	BOYAmt
EOY	$3,120,169	EOYAmt

Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp

Field	Value	IRS element (for citing)
BOY	$1,845,954	BOYAmt
EOY	$636,855	EOYAmt

Field	Value	IRS element (for citing)
Land Bldg Equip Cost Or Other Bss	$108,259,757	LandBldgEquipCostOrOtherBssAmt
Land Bldg Equip Accum Deprec	$55,760,853	LandBldgEquipAccumDeprecAmt

Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp

Field	Value	IRS element (for citing)
BOY	$54,669,036	BOYAmt
EOY	$52,498,904	EOYAmt

Investments Other Securities InvestmentsOtherSecuritiesGrp

Field	Value	IRS element (for citing)
BOY	$26,980,387	BOYAmt
EOY	$22,516,354	EOYAmt

Investments Program Related InvestmentsProgramRelatedGrp

Field	Value	IRS element (for citing)
BOY	$1,101,678	BOYAmt
EOY	$1,943,038	EOYAmt

Intangible Assets IntangibleAssetsGrp

Field	Value	IRS element (for citing)
BOY	$3,096,053	BOYAmt
EOY	$124,320	EOYAmt

Other Assets Total OtherAssetsTotalGrp

Field	Value	IRS element (for citing)
BOY	$0	BOYAmt
EOY	$7,578,045	EOYAmt

Total Assets TotalAssetsGrp

Field	Value	IRS element (for citing)
BOY	$107,934,459	BOYAmt
EOY	$102,725,540	EOYAmt

Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp

Field	Value	IRS element (for citing)
BOY	$10,275,836	BOYAmt
EOY	$10,021,855	EOYAmt

Deferred Revenue DeferredRevenueGrp

Field	Value	IRS element (for citing)
BOY	$0	BOYAmt
EOY	$2,169,973	EOYAmt

Tax Exempt Bond Liabilities TaxExemptBondLiabilitiesGrp

Field	Value	IRS element (for citing)
BOY	$14,753,202	BOYAmt
EOY	$14,287,576	EOYAmt

Escrow Account Liability EscrowAccountLiabilityGrp

Field	Value	IRS element (for citing)
BOY	$16,551	BOYAmt
EOY	$15,187	EOYAmt

Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp

Field	Value	IRS element (for citing)
BOY	$17,157,537	BOYAmt
EOY	$16,163,751	EOYAmt

Other Liabilities OtherLiabilitiesGrp

Field	Value	IRS element (for citing)
BOY	$1,400,958	BOYAmt
EOY	$11,722,411	EOYAmt

Total Liabilities TotalLiabilitiesGrp

Field	Value	IRS element (for citing)
BOY	$43,604,084	BOYAmt
EOY	$54,380,753	EOYAmt

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

No Donor Restriction Net Assets NoDonorRestrictionNetAssetsGrp

Field	Value	IRS element (for citing)
BOY	$60,527,665	BOYAmt
EOY	$45,220,254	EOYAmt

Donor Restriction Net Assets DonorRestrictionNetAssetsGrp

Field	Value	IRS element (for citing)
BOY	$3,802,710	BOYAmt
EOY	$3,124,533	EOYAmt

Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp

Field	Value	IRS element (for citing)
BOY	$64,330,375	BOYAmt
EOY	$48,344,787	EOYAmt

Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp

Field	Value	IRS element (for citing)
BOY	$107,934,459	BOYAmt
EOY	$102,725,540	EOYAmt

Field	Value	IRS element (for citing)
Info In Schedule O Part XI	Yes (X)	InfoInScheduleOPartXIInd
Reconcilation Revenue Expnss	-$16,009,625	ReconcilationRevenueExpnssAmt
Net Unrlzd Gains Losses Invst	$356,806	NetUnrlzdGainsLossesInvstAmt
Other Changes In Net Assets	-$332,769	OtherChangesInNetAssetsAmt
Info In Schedule O Part XII	Yes (X)	InfoInScheduleOPartXIIInd
Method Of Accounting Accrual	Yes (X)	MethodOfAccountingAccrualInd
Accountant Compile Or Review	0	AccountantCompileOrReviewInd
FS Audited	Yes (1)	FSAuditedInd

FS Audited Basis FSAuditedBasisGrp

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

Field	Value	IRS element (for citing)
Audit Committee	Yes (1)	AuditCommitteeInd
Federal Grant Audit Required	0	FederalGrantAuditRequiredInd

Schedule A IRS990ScheduleA

Field	Value	IRS element (for citing)
Hospital	Yes (X)	HospitalInd

Schedule B IRS990ScheduleB

Contributor Information ContributorInformationGrp

Field	Value	IRS element (for citing)
Contributor	RESTRICTED	ContributorNum

Contributor Business Name ContributorBusinessName

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

Contributor US Address ContributorUSAddress

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

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

Schedule C IRS990ScheduleC

Field	Value	IRS element (for citing)
Volunteers	0	VolunteersInd
Paid Staff Or Management	0	PaidStaffOrManagementInd
Media Advertisements	0	MediaAdvertisementsInd
Mailings Members	0	MailingsMembersInd
Publications Or Broadcast	0	PublicationsOrBroadcastInd
Grants Other Organizations	0	GrantsOtherOrganizationsInd
Direct Contact Legislators	0	DirectContactLegislatorsInd
Rallies Demonstrations	0	RalliesDemonstrationsInd
Other Activities	Yes (1)	OtherActivitiesInd
Other Activities	$739	OtherActivitiesAmt
Total Lobbying Expenditures	$739	TotalLobbyingExpendituresAmt
Not Described Section501c3	0	NotDescribedSection501c3Ind

Supplemental Information Detail SupplementalInformationDetail

Field	Value	IRS element (for citing)
Form And Line Reference	Part II-B, Line 1:	FormAndLineReferenceDesc
Explanation	Avera Marshall paid dues to organizations which have a portion of the dues attributed to lobbying activities.	ExplanationTxt

Schedule D IRS990ScheduleD

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

Land LandGrp

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	$1,070,769	OtherCostOrOtherBasisAmt
Book Value	$1,070,769	BookValueAmt

Buildings BuildingsGrp

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	$70,873,449	OtherCostOrOtherBasisAmt
Depreciation	$31,983,582	DepreciationAmt
Book Value	$38,889,867	BookValueAmt

Leasehold Improvements LeaseholdImprovementsGrp

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	$33,172	OtherCostOrOtherBasisAmt
Depreciation	$24,837	DepreciationAmt
Book Value	$8,335	BookValueAmt

Equipment EquipmentGrp

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	$34,792,536	OtherCostOrOtherBasisAmt
Depreciation	$23,217,696	DepreciationAmt
Book Value	$11,574,840	BookValueAmt

Other Land Buildings OtherLandBuildingsGrp

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	$1,489,831	OtherCostOrOtherBasisAmt
Depreciation	$534,738	DepreciationAmt
Book Value	$955,093	BookValueAmt

Field	Value	IRS element (for citing)
Total Book Value Land Buildings	$52,498,904	TotalBookValueLandBuildingsAmt

Other Securities OtherSecuritiesGrp (3 entries)

DescDesc	Book ValueBookValueAmt	Method ValuationMethodValuationCd
Interest in Avera Health Foundation	$3,934,896	F
Assets Limited to Use-Avera Pooled Investments	$18,170,857	F
Other Investments	$410,601	F

Field	Value	IRS element (for citing)
Total Book Value Securities	$22,516,354	TotalBookValueSecuritiesAmt

Other Assets Org OtherAssetsOrgGrp (2 entries)

DescDesc	Book ValueBookValueAmt
Right of Use Asset	$1,298,004
Intercompany Assets	$6,280,041

Field	Value	IRS element (for citing)
Total Book Value Other Assets	$7,578,045	TotalBookValueOtherAssetsAmt

Other Liabilities Org OtherLiabilitiesOrgGrp (4 entries)

DescDesc	AmtAmt
Estimated Third-Party Payor Settlements	$1,202,517
Right of Use Operating Lease Obligations	$1,305,122
Contract Liability - Medicare Advanced Payments	$8,534,543
Deferred Payroll Taxes	$680,229

Field	Value	IRS element (for citing)
Total Liability	$11,722,411	TotalLiabilityAmt
Footnote Text	Yes (X)	FootnoteTextInd

Supplemental Information Detail SupplementalInformationDetail (2 entries)

Form And Line ReferenceFormAndLineReferenceDesc

ExplanationExplanationTxt

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.

Schedule H IRS990ScheduleH

Field	Value	IRS element (for citing)
Financial Assistance Policy	Yes (1)	FinancialAssistancePolicyInd
Written Policy	Yes (1)	WrittenPolicyInd
All Hospitals Policy	Yes (X)	AllHospitalsPolicyInd
FPG Reference Free Care	Yes (1)	FPGReferenceFreeCareInd
Percent150	Yes (X)	Percent150Ind
FPG Reference Discounted Care	Yes (1)	FPGReferenceDiscountedCareInd
Percent400	Yes (X)	Percent400Ind
Free Care Medically Indigent	Yes (1)	FreeCareMedicallyIndigentInd
Financial Assistance Budget	Yes (1)	FinancialAssistanceBudgetInd
Expenses Exceed Budget	Yes (1)	ExpensesExceedBudgetInd
Unable To Provide Care	0	UnableToProvideCareInd
Annual Community Bnft Report	0	AnnualCommunityBnftReportInd

Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$577,113	TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns	$577,113	NetCommunityBenefitExpnsAmt
Total Expense	0.00440	TotalExpensePct

Unreimbursed Medicaid UnreimbursedMedicaidGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$6,152,245	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$5,726,661	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$425,584	NetCommunityBenefitExpnsAmt
Total Expense	0.00320	TotalExpensePct

Total Financial Assistance Typ TotalFinancialAssistanceTyp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$6,729,358	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$5,726,661	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$1,002,697	NetCommunityBenefitExpnsAmt
Total Expense	0.00760	TotalExpensePct

Community Health Services CommunityHealthServicesGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$409,333	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$126,356	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$282,977	NetCommunityBenefitExpnsAmt
Total Expense	0.00220	TotalExpensePct

Health Professions Education HealthProfessionsEducationGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$241,279	TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns	$241,279	NetCommunityBenefitExpnsAmt
Total Expense	0.00180	TotalExpensePct

Subsidized Health Services SubsidizedHealthServicesGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$12,507,806	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$3,923,717	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$8,584,089	NetCommunityBenefitExpnsAmt
Total Expense	0.06550	TotalExpensePct

Cash And In Kind Contributions CashAndInKindContributionsGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$52,010	TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns	$52,010	NetCommunityBenefitExpnsAmt
Total Expense	0.00040	TotalExpensePct

Total Other Benefits TotalOtherBenefitsGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$13,210,428	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$4,050,073	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$9,160,355	NetCommunityBenefitExpnsAmt
Total Expense	0.06990	TotalExpensePct

Total Community Benefits TotalCommunityBenefitsGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$19,939,786	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$9,776,734	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$10,163,052	NetCommunityBenefitExpnsAmt
Total Expense	0.07750	TotalExpensePct

Physical Imprv And Housing PhysicalImprvAndHousingGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$314	TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns	$314	NetCommunityBenefitExpnsAmt
Total Expense	0.00000	TotalExpensePct

Economic Development EconomicDevelopmentGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$1,796	TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns	$1,796	NetCommunityBenefitExpnsAmt
Total Expense	0.00000	TotalExpensePct

Community Support CommunitySupportGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$169,200	TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns	$169,200	NetCommunityBenefitExpnsAmt
Total Expense	0.00130	TotalExpensePct

Leadership Development LeadershipDevelopmentGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$59,002	TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns	$59,002	NetCommunityBenefitExpnsAmt
Total Expense	0.00040	TotalExpensePct

Coalition Building CoalitionBuildingGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$285	TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns	$285	NetCommunityBenefitExpnsAmt
Total Expense	0.00000	TotalExpensePct

Health Improvement Advocacy HealthImprovementAdvocacyGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$1,340	TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns	$1,340	NetCommunityBenefitExpnsAmt
Total Expense	0.00000	TotalExpensePct

Workforce Development WorkforceDevelopmentGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$570	TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns	$570	NetCommunityBenefitExpnsAmt
Total Expense	0.00000	TotalExpensePct

Total Communtity Building Acty TotalCommuntityBuildingActyGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$232,507	TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns	$232,507	NetCommunityBenefitExpnsAmt
Total Expense	0.00170	TotalExpensePct

Field	Value	IRS element (for citing)
Bad Debt Expense Reported	Yes (1)	BadDebtExpenseReportedInd
Bad Debt Expense	$2,566,506	BadDebtExpenseAmt
Bad Debt Expense Attributable	$0	BadDebtExpenseAttributableAmt
Reimbursed By Medicare	$22,083,419	ReimbursedByMedicareAmt
Cost Of Care Reimbursed By Medcr	$21,893,526	CostOfCareReimbursedByMedcrAmt
Medicare Surplus Or Shortfall	$189,893	MedicareSurplusOrShortfallAmt

Costing Methodology Used CostingMethodologyUsedGrp

Field	Value	IRS element (for citing)
Other	Yes (X)	OtherInd

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

Hospital Facilities HospitalFacilitiesGrp

Field	Value	IRS element (for citing)
Facility	1	FacilityNum

Business Name BusinessName

Field	Value	IRS element (for citing)
Business Name Line1	Avera Marshall Regional Medical Center	BusinessNameLine1Txt

US Address USAddress

Field	Value	IRS element (for citing)
Address Line1	300 S Bruce Street	AddressLine1Txt
City	Marshall	CityNm
State Abbreviation	MN	StateAbbreviationCd
ZIP	56258	ZIPCd

Field	Value	IRS element (for citing)
Website Address	www.averamarshall.org	WebsiteAddressTxt
State License	00343	StateLicenseNum
Licensed Hospital	Yes (X)	LicensedHospitalInd
General Medical And Surgical	Yes (X)	GeneralMedicalAndSurgicalInd
Critical Access Hospital	Yes (X)	CriticalAccessHospitalInd
Emergency Room24 Hrs	Yes (X)	EmergencyRoom24HrsInd
Other	7 Provider Based Clinics	OtherDesc

Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp

Hospital Facility Name HospitalFacilityName

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

Field	Value	IRS element (for citing)
Facility	1	FacilityNum
First Licensed CY Or PY	0	FirstLicensedCYOrPYInd
Tax Exempt Hospital CY Or PY	0	TaxExemptHospitalCYOrPYInd
CHNA Conducted	Yes (1)	CHNAConductedInd
Community Definition	Yes (X)	CommunityDefinitionInd
Community Demographics	Yes (X)	CommunityDemographicsInd
Existing Resources	Yes (X)	ExistingResourcesInd
How Data Obtained	Yes (X)	HowDataObtainedInd
Community Health Needs	Yes (X)	CommunityHealthNeedsInd
Other Health Issues	Yes (X)	OtherHealthIssuesInd
Community Hlth Needs Id Process	Yes (X)	CommunityHlthNeedsIdProcessInd
Consulting Process	Yes (X)	ConsultingProcessInd
Prior CHNA Impact	Yes (X)	PriorCHNAImpactInd
CHNA Conducted	18	CHNAConductedYr
Take Into Account Others Input	Yes (1)	TakeIntoAccountOthersInputInd
CHNA Conducted With Other Fclts	0	CHNAConductedWithOtherFcltsInd
CHNA Conducted With Non Fclts	Yes (1)	CHNAConductedWithNonFcltsInd
CHNA Report Widely Available	Yes (1)	CHNAReportWidelyAvailableInd
Rpt Available On Own Website	Yes (X)	RptAvailableOnOwnWebsiteInd
Own Website URL	www.avera.org/marshall/	OwnWebsiteURLTxt
Other Website	Yes (X)	OtherWebsiteInd
Other Website URL	See Part V, Page 8	OtherWebsiteURLTxt
Paper Copy Public Inspection	Yes (X)	PaperCopyPublicInspectionInd
Implementation Strategy Adopt	Yes (1)	ImplementationStrategyAdoptInd
Implementation Strategy Adpt	18	ImplementationStrategyAdptYr
Strategy Posted Website	Yes (1)	StrategyPostedWebsiteInd
Strategy Website URL	See Part V, Page 8	StrategyWebsiteURLTxt
Organization Incur Excise Tax	0	OrganizationIncurExciseTaxInd
Elig Criteria Explained	Yes (1)	EligCriteriaExplainedInd
FPG Family Incm Lmt Free Dscnt	Yes (X)	FPGFamilyIncmLmtFreeDscntInd
FPG Family Incm Lmt Free Care	150.000000000000	FPGFamilyIncmLmtFreeCarePct
FPG Family Incm Lmt Dscnt Care	400.000000000000	FPGFamilyIncmLmtDscntCarePct
Asset Level Criteria	Yes (X)	AssetLevelCriteriaInd
Medical Indigency Criteria	Yes (X)	MedicalIndigencyCriteriaInd
Insurance Status Criteria	Yes (X)	InsuranceStatusCriteriaInd
Other Criteria	Yes (X)	OtherCriteriaInd
Explained Basis	Yes (1)	ExplainedBasisInd
App Financial Asst Expln	Yes (1)	AppFinancialAsstExplnInd
Described Info	Yes (X)	DescribedInfoInd
Described Suprt Doc	Yes (X)	DescribedSuprtDocInd
Provided Hospital Contact	Yes (X)	ProvidedHospitalContactInd
Includes Publicity Measures	Yes (1)	IncludesPublicityMeasuresInd
FAP Available On Website	Yes (X)	FAPAvailableOnWebsiteInd
FAP Available On Website URL	See Part V, Page 8	FAPAvailableOnWebsiteURLTxt
FAP App Available On Website	Yes (X)	FAPAppAvailableOnWebsiteInd
FAP App Available On Website URL	See Part V, Page 8	FAPAppAvailableOnWebsiteURLTxt
FAP Summary On Website	Yes (X)	FAPSummaryOnWebsiteInd
FAP Summary On Website URL	See Part V, Page 8	FAPSummaryOnWebsiteURLTxt
FAP Avlbl On Request No Charge	Yes (X)	FAPAvlblOnRequestNoChargeInd
FAP App Avlbl On Request No Chrg	Yes (X)	FAPAppAvlblOnRequestNoChrgInd
FAP Sum Avlbl On Request No Chrg	Yes (X)	FAPSumAvlblOnRequestNoChrgInd
Notified FAP Copy Bill Display	Yes (X)	NotifiedFAPCopyBillDisplayInd
Communtity Notified FAP	Yes (X)	CommuntityNotifiedFAPInd
FAP Translated	Yes (X)	FAPTranslatedInd
Other Publicity	Yes (X)	OtherPublicityInd
FAP Actions On Nonpayment	Yes (1)	FAPActionsOnNonpaymentInd
Permit No Actions	Yes (X)	PermitNoActionsInd
Collection Activities	0	CollectionActivitiesInd
Provided Written Notice	Yes (X)	ProvidedWrittenNoticeInd
Made Effort Orally Notify	Yes (X)	MadeEffortOrallyNotifyInd
Processed FAP Application	Yes (X)	ProcessedFAPApplicationInd
Made Presumptive Elig Determ	Yes (X)	MadePresumptiveEligDetermInd
Other Actions Taken	Yes (X)	OtherActionsTakenInd
Nondis Emergency Care Policy	Yes (1)	NondisEmergencyCarePolicyInd
Look Back Medicare Private	Yes (X)	LookBackMedicarePrivateInd
Amounts Generally Billed	0	AmountsGenerallyBilledInd
Gross Charges	0	GrossChargesInd

Supplemental Information SupplementalInformationGrp (10 entries)

Form And Line ReferenceFormAndLineReferenceDesc	ExplanationExplanationTxt
Avera Marshall	Part V, Section B, Line 5: The Avera Marshall Regional Medical Center 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 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.
Avera Marshall	Part V, Section B, Line 6b: Southwest Health and Human Services
Avera Marshall	Part V, Section B, Line 11: Page 8, Part V, Section B, Line 11:The community health needs assessment was completed in 2018. The following community health priority areas were identified: Mental Health, Obesity/Diabetes and Tobacco and e-cigarette use and exposure. Avera Marshall initiated measures to address the identified needs, however, the Covid pandemic hindered some actions and programs. Avera Marshall plans to resume actions in the implementation strategy in 2021. Mental Health - Increase the proportion of adults and children with mental health disorders who receive treatment. Improve behavioral health (BH) access and quality care. Increase appropriate use of screening and prevention services. FY2020 Update: Every patient admitted is screened with the PHQ9, GAD7 and AUDIT tool. Using the AUDIT tool, if a patient scores in a range of unhealthy alcohol use we are providing a brief intervention utilizing the SBIRT technique and training. All inpatient hospital staff is trained in SBIRT and motivational interviewing to address readiness for change in regards to substance abuse. An inpatient therapist is trained in performing Rule 25 Assessment, a state of Minnesota administrative rule regarding chemical use assessment. With Rule 25, we are able to get patients referred to the appropriate level of substance use treatment directly from our unit post-discharge.-Increase awareness and reduce stigma around mental health issues and assist disbursing local resource materials. Increase involvement with National Alliance on Mental Illness of Minnesota (NAMI). FY2020 Update: Provide stigma session as part of group programming. Provide handout for local resources and NAMI. -Tap into depression resources -Provide employees with a depression screening toolFY2020 Update: LiveNow Screening offers a depression screening tool for employees. In addition, we are offering weekly sessions with our mental health providers during COVID via webex for all employees. -Provide and enhance utilization of EAP resources FY2020: The LIGHT Program is available to all providers as a resource for mental wellbeing. -Provide better adherence to medical care for those with behavioral health conditions measured by percentage of patients receiving BH screening and percentage of patients discharged with a BH referral. FY2020 Update: All patients discharged from the inpatient side receive post-discharge referrals/appointments to follow up after hospitalization. -Continue to operate mental health services, including inpatient and outpatient psychiatry programs. Partner with mental health providers to offer education on stress management to our patients and the community. FY2020 Update: Inpatients have group programming with sessions focused on symptom management, including stress management. Patients work with staff to create a crisis response plan (CRP) throughout their admission to be completed at discharge. Moving forward, we will be a member of Upper MN River Valley Suicide Prevention Coalition whose goal is to work with community partners to decrease suicide. Through this group we can also offer SAVE training to employees. As part of the Minnesota Hospital Association (MHA) Mental and Behavioral Health Committee, we were on a sub group that designed the inpatient suicide and self-harm road map for MHA. -Further integrate mental health services into Primary Care. Monitor and improve collaborative opportunities between medical and behavioral health care. FY2020 Update: Currently working on an IHP grant with Western Mental Health and care coordination. The Care coordination team works closely with referred patients who have mental health needx and coordinates with Western Mental Health and other outpatient services. -Position Avera Marshall Behavioral Health as a Center of Excellence for the practice of Dialectical Behavior Therapy (DBT) as champion for the Zero Suicide initiative. FY2020 Update: Continue to partner with Zero Suicide. Working with Dr. Craig Bryan on developing his evidence-based treatment that is used in the outpatient setting to a format that will work on a short-term inpatient unit. Select staff have been trained in his B-CBT program. Our inpatient therapist was selected to become a certified trainer in B-CBT which will allow us to have a local resource and expert moving forward. Obesity/Diabetes-Continue to collaborate with partner agencies to assist community members in obtaining needed nutritional information. FY2020 Update: Outpatient bariatric services are resuming on campus with the help of staff dieticians. -Explore potentialities in developing healthy eating and exercising programs to be promoted via affected communities' chambers of commerce and religious organizations. -Promote Obesity screening and counseling FY2020 Update: Continue to educate patients and promote obesity screening and counseling as part of our ACO work and documentation.-Promote Healthy diet and physical activity -Provide hospital classes with Nutrition Services and Dieticians to cook healthierFY2020 Update: Currently no in person classes due to COVID-Provide Weight loss Programs FY2020 Update: Weight loss programs offered by local physicians. -Provide Wellness Coaches -Facility will provide meeting support -Continue working on strategies related to overall BMI improvement -Continue Education and screenings at health fairs and educational events FY 2020 Update: Work with the Schwan's Health Fair-Distribute information on community resources such as free meals and food pantriesFY2020 Update: At COVID Collection Sites we use a flyer handout for resources in Southwest MN including food pantries. Will continue to distribute this flyer through other channels as well. -Support community support groups by providing meeting space, speakers, and educational topics FY2020 Update: Support our regional SMART team (sexual assault) in hosting trainings. Working on virtual, as well as in person, format. Tobacco and e-cigarette use and exposure-Emphasize communication and education on the health risks associated with tobacco and e-cigarette use (vaping) and exposure. -Initiate, promote and enforce smoking/vaping free policies on healthcare facilities grounds and promote asking partnering suppliers and onsite vendors to do the same.-Continue current and expand hospital prevention classes-Facility will provide Tobacco Cessation Programs and meeting support-Employees will participate in community education to promote the prevention of smokingFY2020 Update: Avera has created educational pieces for patients and clinicians that include: 6 ways to help a friend stop vaping, tips to help you quit vaping, vaping, what parents need to know, and what is vaping. There are also guidelines developed for clinicians by the Primary Care Service Line and the Avera Vaping Task Force "Your Patient is Vaping now what?"The following health needs/priorities will not be directly addressed by Avera Marshall due to capability to address by other community assets:-Cardiovascular disease-Cancer-Aging issuesMany of these activities are continuations of activities the hospital has been conducting related to the prior community health needs assessment.
Avera Marshall	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 Marshall	Part V, Section B, Line 16j: A summary of the financial assistance policy is posted in the hospital facility's emergency room, waiting rooms, and admissions office and included in the billing statement. In addition, the financial assistance policy is discussed with the patient upon admission to the facility.
Avera Marshall	Part V, Section B, Line 20e: If a patient is self-pay and has a large balance, an Avera patient advocate will help them apply for other forms of assistance. If they are not eligible for any other coverage, the patient is given a financial assistance application to complete and return to the facility.
Avera Marshall	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 B, Line 7b:	https://www.avera.org/about/community-health-needs-assessments/#marshall
Schedule H, Part V, Section B, Line 10a:	https://www.avera.org/about/community-health-needs-assessments/#marshall
Part V, line 16a-c	The FAP, FAP Application, and Plain Language Summary are available at:https://www.avera.org/patients-visitors/charity-patient-assistance-programs/financial-assistance-forms/

Field	Value	IRS element (for citing)
Facility	9	FacilityNum

Oth Hlth Care Fclts Not Hospital OthHlthCareFcltsNotHospitalGrp

Oth Hlth Care Fclts OthHlthCareFcltsGrp (9 entries)

Address Line1USAddress/AddressLine1Txt	CityUSAddress/CityNm	State AbbreviationUSAddress/StateAbbreviationCd	ZIPUSAddress/ZIPCd	FacilityFacilityTxt
1 - Avera Morningside Heights Care Center
300 S Bruce Street	Marshall	MN	56258	nursing home
2 - Avera Marshall SW Ophthalmology
300 S Bruce Street	Marshall	MN	56258	ophthalmology, optical
3 - AMG Optometry Redwood Falls
500 E Bridge Street	Redwood Falls	MN	56283	optometry, ophthalmology, optical
4 - AveraNow - closed March
900 E Main Street	Marshall	MN	56258	convenience clinic
5 - AMG Optometry Tracy
505 State Street	Tracy	MN	56175	Optometry, ophthalmology, optical
6 - AMG Optometry Springfield
602 N Jackson Ave	Springfield	MN	56087	Optometry, ophthalmology, optical
7 - Avera Medical Group Carlson-closed April
1521 Carlson Street	Marshall	MN	56258	healthcare clinic
8 - Avera Surgery Center Marshall-closed Jan
1521 Carlson Street	Marshall	MN	56258	surgical care
9 - Avera Therapy Marshall
1420 East College Drive	Marshall	MN	56258	physical, speech, and occupational therapy

Supplemental Information Detail SupplementalInformationDetail (14 entries)

Form And Line ReferenceFormAndLineReferenceDesc	ExplanationExplanationTxt
Part I, Line 3c:	The methodology used to determine eligibility for financial assistance takes into consideration income, net assets, family size and resources available to pay for care. In addition, presumptive charity care may be applied in situations where all other avenues have been exhausted.
Part I, Line 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, health professions education, and cash and in-kind contributions are reported based on actual expenses recorded to the general ledger.
Part I, Line 7g:	Provider based clinic costs are included in subsidized health services. Revenues of $1,479,574 and costs of $3,290,281 were included for a net community benefit of $1,810,707.
Part I, Ln 7 Col(f):	Bad debt expense of $29,953 is included on Form 990, Part IX, line 25, column (A) but excluded for purposes of calculating this percentage.
Part II, Community Building Activities:	The organization provides education to community groups, has staff that serve on various comittees/boards, pays the salaries of two police officers, provides leadership development and training for community members, and donates to various community organizations.
Part III, Line 2:	The amount on line 2 represents implicit price concessions and bad debts. The Organization determines its estimate of implicit price concessions based on its historical collection experience with the respective class of patients and residents. Bad debt reflects amounts that will not be paid by patients based on an adverse change in the patient's ability to pay.
Part III, Line 4:	The footnote to the Organization's financial statements that describes implicit price concession and bad debt is located in the audited financial statement report on pages 17 and 18.
Part III, Line 8:	Avera Marshall provides services to patients under the Medicare program knowing they will 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, 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:	In addition to the CHNA, the organization also assesses the needs of the community by utilizing patient surveys, meeting with other organizations to determine needs of the community, and by having the professional medical staff meet/discuss patient needs based on their daily interactions.
Part VI, Line 3:	Anyone who is uninsured receives a letter with their itemized bill which describes both the uninsured program and the charity care program. Any uninsured patient is contacted by phone or letter by the collections department at which time the programs are described. Also, inpatient and same day surgery patients receive a brochure in their admissions packet. Pre-collection letters also include information regarding the charity care and uninsured programs.
Part VI, Line 4:	Avera Marshall is a 25-bed critical access hospital in Marshall, Minnesota. The primary service area is defined as Lyon County, Minnesota, including the communities of Marshall, Minneota, Ghent, Taunton, Lynd, Russell, Cottonwood, Tracy, Balaton and Garvin. Marshall is the county seat. According to the U.S. Census Bureau Quick Facts 2019 data, the estimated population of Lyon County as of July 1, 2019 is 25,474 and is predominately white at 89.6%. It is estimated that 16.5% of the population is 65 years and over. The median household income is $57,730 with a 10.6% poverty rate. Uninsured individuals under age 65 is estimated at 5.1%.
Part VI, Line 5:	The organization's governing body is comprised of volunteer members who reside in the community. Medical staff privileges are extended to all qualified physicians in the community. Surplus funds are reinvested in facilities to improve patient care. Charity care is available for those with a diminished ability to pay. In addition, Avera Marshall is the sole provider for hospital inpatient care, the only physician staffed 24/7 ER, birthing center and full service surgery center. As a result of the mission statement, Avera Marshall provides numerous services which do not produce a profit. An example of this is psychiatric services provided by the facility. This is a subsidized health service. Avera Marshall also operates AveraNow to provide an alternative, low-cost convenience care for walk-in patients. Avera Marshall is very involved in the community. Avera Marshall's leadership team is encouraged to participate in civic and community organizations. Avera Marshall staff also volunteers on a monthly basis to Esther's Kitchen (free meals provided at a local church) and Ruby's Pantry (monthly program providing fresh and frozen foods for a small payment). Avera Marshall offers classes such as childbirth and various other support groups. Planet Heart community screenings are provided with reduced imaging fees in addition to free vein screenings. Avera Marshall provides educational experiences for school-aged children, students needing work study experience and med student internships. Avera employees volunteer through programs such as Junior Achievement. Educational classes are held at the Marshall YMCA. Physicals for sports are given to students who have no means to pay but wish to participate in athletic activities at Marshall schools. Basic supply items are donated to school nurse providers for triage care. Avera Marshall participates in community health events such as Community Connect which provides options on accessing health care resources. On an annual basis Avera Marshall provides scholarships for medical students. The Foundation, a department of Avera Marshall, focused on raising dollars for community health needs, such as assistance with mammograms through the Tough Enough to Wear Pink campaign, the baby hat and blanket fund and more. All fundraising activities go through Avera Health, a related organization. Avera Marshall also offers many opportunities for community members to volunteer. In partnership with Big Stone Therapies, Avera Marshall provides athletic trainers to many high schools throughout the Marshall region with no cost to the schools districts.
Part VI, Line 6:	Avera is a sponsored ministry of the Benedictine and Presentation Sisters. The communities in which Avera operates all have unique health and community benefit needs. In keeping with the Catholic Healthcare Association guidelines, each hospital strives to meet its community's identified needs. The corporate staff of Avera Health advocates for all members regarding community benefit related matters of state, regional and national importance.

Schedule I IRS990ScheduleI

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

Recipient Table RecipientTable

Recipient Business Name RecipientBusinessName

Field	Value	IRS element (for citing)
Business Name Line1	University of MN Foundation Medical School Duluth Campus	BusinessNameLine1Txt

US Address USAddress

Field	Value	IRS element (for citing)
Address Line1	1035 University Dr	AddressLine1Txt
City	Duluth	CityNm
State Abbreviation	MN	StateAbbreviationCd
ZIP	55812	ZIPCd

Field	Value	IRS element (for citing)
Recipient EIN	416007513	RecipientEIN
IRC Section	Governmental	IRCSectionDesc
Cash Grant	$48,000	CashGrantAmt
Purpose Of Grant	Physician Recruitment	PurposeOfGrantTxt

Field	Value	IRS element (for citing)
Total501c3 Org	1	Total501c3OrgCnt

Supplemental Information Detail SupplementalInformationDetail

Field	Value	IRS element (for citing)
Form And Line Reference	Part I, Line 2:	FormAndLineReferenceDesc
Explanation	The Organization works with University of MN Foundation Medical School Duluth Campus to identify student recipients for scholarship awards. The Organization makes a recommendation as to who should receive the award, but the Foundation has ultimate authority in choosing the recipient. The Organization monitors the use of the scholarships through a recruiter who maintains contact with the selected students and monitors receipt of the scholarship by the learning institution.	ExplanationTxt

Schedule J IRS990ScheduleJ

Field	Value	IRS element (for citing)
Severance Payment	0	SeverancePaymentInd
Supplemental Nonqual Rtr Plan	0	SupplementalNonqualRtrPlanInd
Equity Based Comp Arrngm	0	EquityBasedCompArrngmInd
Comp Based On Revenue Of Flng Org	0	CompBasedOnRevenueOfFlngOrgInd
Comp Bsd On Rev Related Orgs	0	CompBsdOnRevRelatedOrgsInd
Comp Bsd Net Earns Flng Org	0	CompBsdNetEarnsFlngOrgInd
Comp Bsd Net Earns Rltd Orgs	0	CompBsdNetEarnsRltdOrgsInd
Any Non Fixed Payments	0	AnyNonFixedPaymentsInd
Initial Contract Exception	0	InitialContractExceptionInd

Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (11 entries)

TitleTitleTxt	Base Compensation Filing OrgBaseCompensationFilingOrgAmt	Compensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmt	Bonus Filing OrganizationBonusFilingOrganizationAmount	Bonus Related OrganizationsBonusRelatedOrganizationsAmt	Other Compensation Filing OrgOtherCompensationFilingOrgAmt	Other Compensation Rltd OrgsOtherCompensationRltdOrgsAmt	Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt	Deferred Comp Rltd OrgsDeferredCompRltdOrgsAmt	Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt	Nontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmt	Total Compensation Filing OrgTotalCompensationFilingOrgAmt	Total Compensation Rltd OrgsTotalCompensationRltdOrgsAmt	Comp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmt	Comp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt
Vikram Chatrath MD
Orthopedics & Surgery	$805,054	$0	$274,843	$0	$2,973	$0	$14,000	$0	$39,494	$0	$1,136,364	$0	$0	$0
Jim Breckenridge - Left 42020
CFO Avera Health; Sec/Treasurer	$0	$945,274	$0	$1,760	$0	$71,132	$0	$14,000	$0	$22,856	$0	$1,055,022	$0	$0
Curtis Louwagie MD
Director/Ophthalmologist	$690,253	$0	$65,009	$0	$4,118	$0	$14,000	$0	$34,258	$0	$807,638	$0	$0	$0
Alain Desy MD
Orthopedics & Surgery	$605,207	$0	$0	$0	$53,371	$0	$14,000	$0	$32,494	$0	$705,072	$0	$0	$0
Julie Lautt - Joined 42020
CFO Avera Health; Sec/Treasurer	$0	$516,081	$0	$400	$0	$1,973	$0	$14,000	$0	$21,583	$0	$554,037	$0	$0
Trent Carlson
General Surgery	$451,717	$0	$15,000	$0	$22,904	$0	$14,000	$0	$21,440	$0	$525,061	$0	$0	$0
Maggie Jane Steinbeisser
General Surgery	$438,297	$0	$15,850	$0	$24,103	$0	$14,000	$0	$29,955	$0	$522,205	$0	$0	$0
Miranda Renfrow DO
Ophthalmology	$443,121	$0	$7,500	$0	$35,346	$0	$12,065	$0	$8,382	$0	$506,414	$0	$0	$0
Mary B Maertens
President & CEO	$0	$440,845	$0	$930	$0	$10,631	$0	$14,000	$0	$27,358	$0	$493,764	$0	$0
Sharon WilliamsFormer
Sec/Treas & VP Finance	$0	$179,109	$0	$1,225	$0	$1,817	$0	$9,481	$0	$25,336	$0	$216,968	$0	$0
Doris Derynck
VP Clinical Operations/CNO	$177,199	$0	$930	$0	$1,748	$0	$9,269	$0	$23,212	$0	$212,358	$0	$0	$0

Supplemental Information Detail SupplementalInformationDetail

Field	Value	IRS element (for citing)
Form And Line Reference	Schedule J, Part I, Line 3:	FormAndLineReferenceDesc
Explanation	The President/CEO is compensated by Avera Health. Avera Marshall relied on the related organization for determining the compensation for the President/CEO using the methods described in Part I, Line 3.	ExplanationTxt

Schedule O IRS990ScheduleO

Supplemental Information Detail SupplementalInformationDetail (14 entries)

Form And Line ReferenceFormAndLineReferenceDesc	ExplanationExplanationTxt
Form 990, Part VI, Section A, line 1	The Executive Committee is subject to the direction of the Board of Directors. However, in the case of an emergency, the Executive Committee may exercise all the powers of the board provided that any actions taken shall be reported to the board as quickly as possible. The Chair, Vice-Chair, and Past Chair will make up the composition of the Executive Committee. The President/CEO will serve as a non-voting, ex-officio member of the Executive Committee.
Form 990, Part VI, Section A, line 2	Jim Breckenridge, Julie Lautt, Mary Maertens and Sharon Williams have a business relationship.
Form 990, Part VI, Section A, line 6	The sole member of the organization is Avera Health, a nonprofit corporation organized and existing under the laws of the state of South Dakota and exempt under 501(c)(3) of the Internal Revenue Code of 1986, as amended.
Form 990, Part VI, Section A, line 7a	Avera Health, as the sole member, has the power to appoint and remove, with or without cause, members of the board of directors.
Form 990, Part VI, Section A, line 7b	Avera Health, as the sole member, has the following rights as the member: 1. To approve the adoption, amendment or repeal of the statements of philosophy, mission and values of corporation; 2. To initiate the adoption, amendment or repeal of any provision of the articles of incorporation or bylaws of corporation, and to give final approval of any such action with respect thereto; 3. To approve and act upon the alienation of real property and precious artifacts under the canonical stewardship of the Sisters of the Presentation of the Blessed Virgin Mary of Aberdeen, South Dakota ("Presentation Sisters") or the Benedictine Sisters of Sacred Heart Monastery ("Benedictine Sisters"), pursuant to the policies established by the member; 4. To approve any plan of merger, consolidation or dissolution of the corporation, or the divestiture of a sponsored work or ministry associated with the corporation; 5. To approve the creation of new sponsored works or ministries to be conducted by or under the authority of the corporation; 6. To appoint and remove, with or without cause, the board of directors of the corporation; 7. To appoint and/or remove, with or without cause, the President and Chief Executive Officer of the corporation; 8. To approve operating/capital budgets and strategic plans of the corporation; 9. To approve expenditures outside of operating and capital budgets exceeding defined thresholds according to policy which may be adopted from time to time by the member; 10. To approve acquisitions, sales and leases, according to policy which may be adopted from time to time by the members; 11. To establish and maintain employee benefit programs; 12. To establish and maintain insurance programs; 13. To approve major community fund drives; 14. To approve the appointment of auditors; 15. To adopt policies designed to effectuate the reserved powers of the member.
Form 990, Part VI, Section 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 15b	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 Marshall.
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	Repairs and Maintenance: Program service expenses 2,723,071. Management and general expenses 135,958. Fundraising expenses 0. Total expenses 2,859,029. Purchased Services: Program service expenses 16,545,747. Management and general expenses 1,038,657. Fundraising expenses 15,450. Total expenses 17,599,854. Centralized Services: Program service expenses 0. Management and general expenses 10,301,208. Fundraising expenses 0. Total expenses 10,301,208. Medical Prof Fees: Program service expenses 1,985,011. Management and general expenses 231,480. Fundraising expenses 0. Total expenses 2,216,491.
Form 990, Part XI, line 9:	Equity transfer to related parties -139,645. Other change in net assets held by Avera Health Foundation -193,124.
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 Marshall.
Form 990, Part VI, 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.)

Schedule R IRS990ScheduleR

Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (17 entries)

Address Line1USAddress/AddressLine1Txt	CityUSAddress/CityNm	State AbbreviationUSAddress/StateAbbreviationCd	ZIPUSAddress/ZIPCd	EINEIN	Primary ActivitiesPrimaryActivitiesTxt	Legal Domicile StateLegalDomicileStateCd	Exempt Code SectionExemptCodeSectionTxt	Public Charity StatusPublicCharityStatusTxt	Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt	Controlled OrganizationControlledOrganizationInd	Direct Controlling NADirectControllingNACd
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 Holy Family
826 N 8th Street	Estherville	IA	51334	420680370	Healthcare Services	IA	501(c)(3)	Line 3	Avera Health	0
Avera Holy Family Foundation
826 N 8th Street	Estherville	IA	51334	421317452	Support of 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	460226738	Support of 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	Gettsyburg	SD	57442	460234354	Healthcare Services	SD	501(c)(3)	Line 3	Avera St Mary's	0
Avera at Home
5116 S Solberg Av	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 Education	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 Health
3900 West Avera Drive Suite 300	Sioux Falls	SD	57108	460422673	Healthcare Services	SD	501(c)(3)	Line 10		0	N/A
Avera Tyler
240 Willow Street	Tyler	MN	56178	410853163	Healthcare Services	MN	501(c)(3)	Line 3	Avera Marshall	Yes (1)
Avera Health Plans Inc
3900 West Avera Drive Suite 101	Sioux Falls	SD	57108	460451539	Health Financing and Health Plan Admin	SD	501(c)(4)		Avera Health	0
Avera Granite Falls
345 10th Ave	Granite Falls	MN	56241	843156881	Healthcare services	MN	501(c)(3)	Line 3	Avera Marshall	Yes (1)

Id Related Org Txbl Partnership IdRelatedOrgTxblPartnershipGrp (10 entries)

Address Line1USAddress/AddressLine1Txt	CityUSAddress/CityNm	State AbbreviationUSAddress/StateAbbreviationCd	ZIPUSAddress/ZIPCd	EINEIN	Primary ActivitiesPrimaryActivitiesTxt	Legal Domicile StateLegalDomicileStateCd	Direct Controlling NADirectControllingNACd
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
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
Q & M Properties
525 North Foster	Mitchell	SD	57301	731652049	Medical Clinic Building	SD	N/A
Surgical Associates Endoscopy Clinic LLC
310 S Pennsylvania	Aberdeen	SD	57401	460461429	Surgical Associates	SD	N/A
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
Heart Hospital of South Dakota LLC
4500 W 69th Street	Sioux Falls	SD	57108	562143771	Healthcare Services	SD	N/A
Brookings Health System - Avera HME LLC
101 22nd Ave Suite 101	Brookings	SD	57006	453204123	Medical services - Home Medical Equipment	SD	N/A
National Rural ACO 4 LLC dba Prairie Hills Organization
7509 NW Tiffany Springs Parkway	Kansas City	MO	64153	371780735	Accountable Care Organization	KS	N/A
National Rural ACO 5 LLC dba Great Plains Care Organization
7509 NW Tiffany Springs Parkway	Kansas City	MO	64153	383958290	Accountable Care Organization	KS	N/A
Caravan Health ACO 41 LLC dba Prairie View Care Organization
7509 NW Tiffany Springs Parkway	Kansas City	MO	64153	821447782	Accountable Care Organization	KS	N/A

Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp (6 entries)

Address Line1USAddress/AddressLine1Txt	CityUSAddress/CityNm	State AbbreviationUSAddress/StateAbbreviationCd	ZIPUSAddress/ZIPCd	EINEIN	Primary ActivitiesPrimaryActivitiesTxt	Legal Domicile StateLegalDomicileStateCd	Direct Controlling NADirectControllingNACd	Entity TypeEntityTypeTxt	Controlled OrganizationControlledOrganizationInd
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 Medical 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

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

Transactions Related Org TransactionsRelatedOrgGrp (4 entries)

Transaction TypeTransactionTypeTxt	InvolvedInvolvedAmt	Method Of Amount DeterminationMethodOfAmountDeterminationTxt
Avera Tyler
L	$989,652	General ledger
Avera Tyler
Q	$1,705,300	General ledger
Avera Tyler
R	$150,000	General ledger
Avera Granite Falls
Q	$2,225,746	General ledger