2021-05-17T13:17:02-05:00 2020-06-30 450250958 Eide Bailly LLP 800 Nicollet Mall Ste 1300 Minneapolis MN 554027033 990 2019-07-01 410919153 Avera Marshall AVER 5075329661 300 S Bruce Street Marshall MN 562581934 Julie Lautt CFO Avera Health 5075329661 2021-05-11 1 Kim Hunwardsen CPA P00484560 6122536500 2021-05-11 2019 2022-09-23 18:48:47Z Avera Marshall Regional Medical Center Debbie Streier 300 S Bruce Street Marshall MN 562581934 115308262 0 X www.avera.org X 1944 MN Promotion of health 13 10 880 137 34153 20689 279101 6251034 96686666 108617104 965081 123444 93441 164663 98024289 115156245 25000 53000 0 0 57506424 59184087 0 0 136298 47208159 71928783 104739583 131165870 -6715294 -16009625 107934459 102725540 43604084 54380753 64330375 48344787 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 guided by Christian values. 0 0 113786583 53000 108676072 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. 113786583 1 1 0 1 0 0 0 0 1 0 1 1 0 1 1 1 0 1 0 0 0 0 0 0 0 0 1 1 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 1 125 0 1 880 1 1 1 0 0 0 0 0 0 0 0 0 0 0 X 13 10 1 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 0 1 1 0 MN X Jamie Schaefer 6053223992 3900 W Avera Dr Ste 300 Sioux Falls SD 57108 Vikram Chatrath MD Orthopedics & Surgery 40.00 0.00 X 1082870 0 53495 Jim Breckenridge - Left 42020 CFO Avera Health; Sec/Treasurer 0.10 41.30 X 0 1018166 36856 Curtis Louwagie MD Director/Ophthalmologist 41.30 1.30 X 759380 0 48258 Alain Desy MD Orthopedics & Surgery 40.00 0.00 X 658578 0 46495 Julie Lautt - Joined 42020 CFO Avera Health; Sec/Treasurer 0.10 40.70 X 0 518454 35583 Trent Carlson General Surgery 40.00 0.00 X 489621 0 35440 Maggie Jane Steinbeisser General Surgery 40.00 0.00 X 478250 0 43954 Miranda Renfrow DO Ophthalmology 40.00 0.00 X 485967 0 20447 Mary B Maertens President & CEO 41.30 2.30 X X 0 452406 41358 Sharon WilliamsFormer Sec/Treas & VP Finance 0.00 40.00 X 0 182151 34817 Doris Derynck VP Clinical Operations/CNO 40.00 1.00 X 179877 0 32481 Joyce Strootman Chair 1.30 1.30 X X 0 0 0 Doug Olsem Vice Chair 1.30 1.30 X X 0 0 0 Stephen Crim Director 1.30 1.30 X 0 17395 0 Sr Jodie Zimmerman Director 1.30 1.30 X 0 0 0 Sr Roxanne Seifert Director 1.30 1.30 X 0 0 0 Todd Bock Director 1.30 1.30 X 0 0 0 Amanda Sieling Director 1.30 1.30 X 0 0 0 Randy Serreyn Director 1.30 1.30 X 0 0 0 Quentin Fixen Director 1.30 1.30 X 0 0 0 Laurie Johansen Director 1.30 1.30 X 0 0 0 George Jorgensen Director 1.30 2.30 X 0 0 0 4134543 2188572 429184 100 1 1 0 Avera Health 3900 W Avera Dr Ste 301 Sioux Falls SD 57108 Shared services 10035702 Carris Health 301 Becker Ave SW Willmar MN 56201 Physician/Shared Services 6727112 Big Stone Therapies Inc 500 Cross St Big Stone City SD 571175045 PT, OT, and Speech Therapy 4331160 Avera McKennan 1325 S Cliff Ave Sioux Falls SD 57117 Physicians and Anciliary 2701324 Journey Group Companies 4500 W 58th Street Sioux Falls SD 57108 Construction Services 2302698 24 206480 6044554 12135 6251034 Net Patient Service Revenue 622110 106933038 106933038 Pharmacy Revenue 900099 907437 907437 Cafeteria Revenue 900099 254694 254694 Partnership Revenue/Loss 900099 -183471 -183471 705406 671253 34153 108617104 84714 13172 71542 71542 71542 212289 50000 0 138845 212289 -88845 123444 123444 Operating interest 900099 93121 93121 93121 115156245 108676072 34153 194986 X 48000 48000 5000 5000 1005295 787700 217595 207759 207759 46110188 45359271 668729 82188 2196719 2140468 53624 2627 6700142 6485647 191271 23224 2963984 2872322 84919 6743 319477 319477 5250 5250 739 739 32976582 21253829 11707303 15450 1079 118 961 923393 563793 357581 2019 719159 84943 634216 1961482 1658241 303241 487313 462519 22426 2368 269574 268111 1463 1166898 1077284 89614 5988269 5450916 536892 461 328379 323174 5205 Medical Supplies 20539794 20475198 64477 119 Equipment Lease/Rental 211001 210841 160 Bad Debt 29953 29953 Provision for income ta 3500 3500 5996941 4220505 1775337 1099 131165870 113786583 17242989 136298 2083312 1277978 5857 15816 15362271 13014061 2789911 3120169 1845954 636855 108259757 55760853 54669036 52498904 26980387 22516354 1101678 1943038 3096053 124320 0 7578045 107934459 102725540 10275836 10021855 0 2169973 14753202 14287576 16551 15187 17157537 16163751 1400958 11722411 43604084 54380753 X 60527665 45220254 3802710 3124533 64330375 48344787 107934459 102725540 X -16009625 356806 -332769 X X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 739 739 0 Part II-B, Line 1: Avera Marshall paid dues to organizations which have a portion of the dues attributed to lobbying activities. 0 1 X 1070769 1070769 70873449 31983582 38889867 33172 24837 8335 34792536 23217696 11574840 1489831 534738 955093 52498904 Interest in Avera Health Foundation 3934896 F Assets Limited to Use-Avera Pooled Investments 18170857 F Other Investments 410601 F 22516354 Right of Use Asset 1298004 Intercompany Assets 6280041 7578045 Estimated Third-Party Payor Settlements 1202517 Right of Use Operating Lease Obligations 1305122 Contract Liability - Medicare Advanced Payments 8534543 Deferred Payroll Taxes 680229 11722411 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 1 X 1 1 1 0 0 577113 577113 0.00440 6152245 5726661 425584 0.00320 6729358 5726661 1002697 0.00760 409333 126356 282977 0.00220 241279 241279 0.00180 12507806 3923717 8584089 0.06550 52010 52010 0.00040 13210428 4050073 9160355 0.06990 19939786 9776734 10163052 0.07750 314 314 0.00000 1796 1796 0.00000 169200 169200 0.00130 59002 59002 0.00040 285 285 0.00000 1340 1340 0.00000 570 570 0.00000 232507 232507 0.00170 1 2566506 0 22083419 21893526 189893 X 1 1 1 1 Avera Marshall Regional Medical Center 300 S Bruce Street Marshall MN 56258 www.averamarshall.org 00343 X X X X 7 Provider Based Clinics Avera Marshall 1 0 0 1 X X X X X X X X X 18 1 0 1 1 X www.avera.org/marshall/ X See Part V, Page 8 X 1 18 1 See Part V, Page 8 0 1 X 150.000000000000 400.000000000000 X X X X 1 1 X X X 1 X See Part V, Page 8 X See Part V, Page 8 X See Part V, Page 8 X X X X X X X 1 X 0 X X X X X 1 X 0 0 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/ 9 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 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. 1 University of MN Foundation Medical School Duluth Campus 1035 University Dr Duluth MN 55812 416007513 Governmental 48000 Physician Recruitment 1 Part I, Line 2: 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. 0 0 0 0 0 0 0 0 0 Vikram Chatrath MD Orthopedics & Surgery 805054 0 274843 0 2973 0 14000 0 39494 0 1136364 0 0 0 Jim Breckenridge - Left 42020 CFO Avera Health; Sec/Treasurer 0 945274 0 1760 0 71132 0 14000 0 22856 0 1055022 0 0 Curtis Louwagie MD Director/Ophthalmologist 690253 0 65009 0 4118 0 14000 0 34258 0 807638 0 0 0 Alain Desy MD Orthopedics & Surgery 605207 0 0 0 53371 0 14000 0 32494 0 705072 0 0 0 Julie Lautt - Joined 42020 CFO Avera Health; Sec/Treasurer 0 516081 0 400 0 1973 0 14000 0 21583 0 554037 0 0 Trent Carlson General Surgery 451717 0 15000 0 22904 0 14000 0 21440 0 525061 0 0 0 Maggie Jane Steinbeisser General Surgery 438297 0 15850 0 24103 0 14000 0 29955 0 522205 0 0 0 Miranda Renfrow DO Ophthalmology 443121 0 7500 0 35346 0 12065 0 8382 0 506414 0 0 0 Mary B Maertens President & CEO 0 440845 0 930 0 10631 0 14000 0 27358 0 493764 0 0 Sharon WilliamsFormer Sec/Treas & VP Finance 0 179109 0 1225 0 1817 0 9481 0 25336 0 216968 0 0 Doris Derynck VP Clinical Operations/CNO 177199 0 930 0 1748 0 9269 0 23212 0 212358 0 0 0 Schedule J, Part I, Line 3: 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. 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.) 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 N/A 0 Avera Tyler 240 Willow Street Tyler MN 56178 410853163 Healthcare Services MN 501(c)(3) Line 3 Avera Marshall 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 1 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 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 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 0 1 1 0 Avera Tyler L 989652 General ledger Avera Tyler Q 1705300 General ledger Avera Tyler R 150000 General ledger Avera Granite Falls Q 2225746 General ledger