2019-05-14T15:28:41-05:00 2018-06-30 450250958 Eide Bailly LLP 800 Nicollet Mall Ste 1300 Minneapolis MN 554027033 990 2017-07-01 460399291 Avera at Home AVER 6053224597 3901 W 59th Street Sioux Falls SD 57108 Jim Breckenridge CFO Avera Health 6053224597 2019-05-13 1 Kim Hunwardsen CPA P00484560 6122536500 2019-05-16 8.39.233.107 2019-05-13 09:52:57 CD P D8A1E5117AA53286D53F57459EBB2DE5C7CA50FC EFC25E59FA7409AE560978A003AFB9E955B778C6 2017 2019-02-21 02:37:17Z Sandra Dieleman 3901 W 59th Street Sioux Falls SD 57108 43731820 0 X None X 1987 SD Develop programs for community based services: Home Health, Hospice Care, & Home Medical Equipment. 13 4 495 187 1928 0 382780 270566 39438964 43459410 0 1844 0 0 39821744 43731820 0 0 0 0 23646201 26448666 0 0 0 16826968 18711954 40473169 45160620 -651425 -1428800 16718890 18214757 5803961 7978628 10914929 10236129 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 39232190 43459510 Avera at Home provides a variety of home care services that make it possible for individuals to remain in their home rather than long-term residential or nursing home facilities. Avera at Home is a full-service, accredited home medical equipment provider offering a variety of medical and health-related items for purchase or rent. Additionally, it provides quality home health care with a full range of skilled nursing, therapy, and home health aide services.Finally, Avera at Home provides hospice care for people facing a life-limiting illness or injury. Quality, compassionate care is provided in the patient's home or within a 16-bed residential and inpatient care hospice facility in Sioux Falls, Douth Dakota. 39232190 1 1 0 0 0 0 0 0 0 0 1 0 0 0 1 1 0 1 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 33 0 1 495 1 1 1 0 0 0 0 0 0 0 0 0 X 13 4 1 0 0 0 1 1 1 1 0 0 0 1 1 1 1 1 1 0 1 0 MN X Jamie Schaefer 6053223992 3900 W Avera Dr Ste 300 Sioux Falls SD 57108 Thomas Alan Clark Board Chair 0.50 40.00 X X 0 499210 40774 Curtis John Hohman Board Vice Chair 0.50 40.00 X X 0 345074 23333 Jamie Schaefer Secretary 0.50 40.00 X X 0 239529 38216 Tom Snyder Board Member 0.50 40.00 X 0 173153 19487 Dr Nanci J Van Peursem Board Member 0.50 40.00 X 0 296590 36383 Gerald Dean Beninga Board Member 0.50 0.00 X 0 0 0 Sr Kathleen Ann Bierne Board Member 0.50 0.00 X 0 0 0 Doris Margaret Derynck Board Member 0.50 40.00 X 0 176835 31363 Timothy Dougherty Board Member 0.50 0.00 X 0 0 0 Chad Thury MD Board Member 0.50 40.00 X 0 275608 43503 Sister Debra Kolecka Board Member 0.50 7.00 X 0 0 0 Karen Sue Gallagher Board Member 0.50 40.00 X 0 134034 35150 Sandy Dieleman CEO 40.00 0.00 X X 0 296722 37061 Jim Breckenridge CFO Avera Health 0.10 39.90 X 0 887406 34116 Nathan Brand Director of Finance 40.00 0.00 X 38121 31193 26407 Robbie RedlinDirector of Business Development 40.00 0.00 X 137512 0 25160 Paul Harbaugh VP HMS 40.00 0.00 X 144052 0 29206 Rhonda Wiering Regional Director 40.00 0.00 X 144932 0 30337 Carla Van Dyke Regional Director 40.00 0.00 X 116166 0 16068 Cynda Jones Director of Patient Access 40.00 0.00 X 113009 0 33387 Nichole Cody Former VP of Finance 0.50 40.00 X 81997 75572 14708 775789 3430926 514659 7 1 1 0 Avera Health 3900 West Avera Drive Sioux Falls SD 57108 Shared Services 2519502 John Decker 46507 Lorraine Circle Hartford SD 57013 Physical Therapy Services 447836 BrighTree LLC 1735 N Brown Rd NW Suite 500 Lawrenceville GA 30043 Billing Services and Software 263713 Avera Marshall 300 S Bruce St Marshall MN 56258 Staffing 193664 Avera St Mary's 801 E Sioux Avenue Pierre SD 57501 Staffing 164170 9 270566 270566 Patient revenue 624120 42537035 42535107 1928 Home Medical Equipment revenue 624120 634366 634366 288009 288009 43459410 1844 1844 43731820 43457482 1928 1844 12278 12278 20514132 18068240 2445892 1210015 1040218 169797 3429162 3127042 302120 1283079 1135910 147169 406 406 4430981 2866191 1564790 47990 8507 39483 791642 750902 40740 333312 113544 219768 1026895 921352 105543 944383 866585 77798 41504 13774 27730 1332466 1245843 86623 157756 93097 64659 Medical supplies 8176153 7774251 401902 Bad Debt Expense 690306 690306 Food transfer 57309 53581 3728 680851 462847 218004 45160620 39232190 5928430 0 3919510 5752648 5979336 5949812 1160750 1019707 192621 157232 12719287 8223947 4754568 4495340 637061 755842 75044 75044 0 9132 16718890 18214757 3576072 3793272 2227889 4185356 5803961 7978628 X 10914929 10236129 10914929 10236129 16718890 18214757 X -1428800 750000 X X 0 1 X 1 0 X 183188 181366 209587 382780 270566 1227487 10504096 16769562 33305976 39410889 43457482 143448005 10687284 16950928 33515563 39793669 43728048 144675492 0 0 0 144675492 41959 6250 415 48624 10687284 16950928 33557522 39799919 43728463 144724116 0.99970 0.99780 0.00000 X 4654864 2708006 1946858 369130 203254 165876 7695293 5312687 2382606 4495340 Due from Related Party 4185356 4185356 X Part X, Line 2: Avera Health and most of its sponsored organizations are considered nonprofit corporations as described in Section 501(c)(3) of the Internal Revenue Code and are exempt from federal income taxes on related income pursuant to Section 501(a) of the Internal Revenue Code. These organizations are required to file a Return of Organization Exempt from Income Tax (Form 990) with the Internal Revenue Service (IRS). Avera Health and certain sponsored organizations also file an Exempt Organization Business Income Tax Return (Form 990T) with the IRS to report their unrelated business taxable income. 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. The federal Form 990T filings and taxable subsidiary returns for consolidated subsidiaries are no longer subject to federal tax examinations by tax authorities for years before 2015. Certain consolidated entities are subject to federal income taxes. Deferred income tax assets and liabilities are recognized for the differences between the financial and income tax reporting basis of assets and liabilities based on enacted tax rates and laws. Deferred tax assets and liabilities are not material as of June 30, 2018 and 2017. The Organization paid an immaterial amount of federal and state income taxes for the years ended June 30, 2018 and 2017. 0 0 0 0 0 0 0 0 0 Thomas Alan Clark Board Chair 0 372788 0 800 0 125622 0 13500 0 27274 0 539984 0 0 Curtis John Hohman Board Vice Chair 0 287573 0 55032 0 2469 0 13500 0 9833 0 368407 0 0 Jamie Schaefer Secretary 0 224122 0 0 0 15407 0 11869 0 26347 0 277745 0 0 Tom Snyder Board Member 0 171613 0 0 0 1540 0 8697 0 10790 0 192640 0 0 Dr Nanci J Van Peursem Board Member 0 169270 0 126031 0 1289 0 12880 0 23503 0 332973 0 0 Doris Margaret Derynck Board Member 0 159258 0 0 0 17577 0 8461 0 22903 0 208199 0 0 Chad Thury MD Board Member 0 197807 0 76832 0 969 0 13500 0 30003 0 319111 0 0 Karen Sue Gallagher Board Member 0 119451 0 2500 0 12083 0 7182 0 27968 0 169184 0 0 Sandy Dieleman CEO 0 263728 0 12236 0 20758 0 11370 0 25691 0 333783 0 0 Jim Breckenridge CFO Avera Health 0 815781 0 0 0 71625 0 13500 0 20616 0 921522 0 0 Robbie RedlinDirector of Business Development 122502 0 9692 0 5318 0 6706 0 18455 0 162673 0 0 0 Paul Harbaugh VP HMS 132550 0 7724 0 3778 0 2959 0 26247 0 173258 0 0 0 Rhonda Wiering Regional Director 119021 0 4443 0 21468 0 6903 0 23434 0 175269 0 0 0 Nichole Cody Former VP of Finance 81545 60568 0 6691 452 8313 4236 3889 3807 2776 90040 82237 0 0 Schedule J, Part I, Line 3: The top management officer's compensation is paid by a related organization, Avera Health. Avera at Home relied on the related organization for determining the compensation for the top management officer using the methods described in Part I, Line 3. Form 990, Part VI, Section A, line 2 Jim Breckenridge, Thomas Clark, Sandra Dieleman, Jamie Schaefer and Sister Debra Kolecka 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 has the following rights as Member of the organization. (a) To approve the adoption, amendment or repeal of the statements of philosophy, mision and values of Corporation; (b) 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; (c) 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; (d) 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; (e) To approve the creation of new sponsored works or ministries to be conducted by or under the authority of the Corporation; (f) To appoint and remove, with or without cause, the Board of Directors of the Corporation; (g) To appoint and/or remove, with or without cause, the President and Chief Executive Officer of the Corporation; (h) To approve operating/capital budgets and strategic plans of the Corporation; (i) 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; (j) To approve acquisitions, sales and leases, according to policy which may be adopted from time to time by the Member; (k) To establish and maintain employee benefit programs; (l) To establish and maintain insurance programs; (m) To approve major community fund drives; (n) To approve the appointment of auditors; (o) To adopt policies designed to effectuate the reserved powers of the Member; (p) To initiate and give final approval to equity and asset transfers by and between the Member and the Corporation and any affiliates or subsidiaries of the Member; (q) To initiate and give final approval to (i) any and all issuances of obligations under any existing or future master indentures binding the Corporation, any indebtedness (including, without limitation, capitalized leases) in excess of dollar thresholds as may be from time to time established by the Member, and (ii) any pledges of collateral for such indebtedness and any pledges of real estate as collateral for any indebtedness regardless of amount; (r) (i) Full and exclusive power to execute supplemental master indentures, including, without limitation, those authorizing the issuance of obligations or series of obligations, (ii) full and exclusive power to prepare, or authorize the preparation of, any and all documents, agreements, swap agreements, investment contracts, certificates and disclosure materials (including, without limitation, Official Statements and any supplements thereto) reasonably and ordinarily prepared in connection with the issuance of obligations thereunder, or related bonds associated therewith and to execute and deliver such items to the appropriate parties in connection therewith and (iii) full and exclusive power to authorize the entrance of members to, or withdrawal of members from, any obligated group, subject to the other requirements of the applicable master indenture for such entrance or withdrawal. Form 990, Part VI, Section A, line 8b The organization does not have a committee with authority to act on behalf of the governing board. 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, each board member is expected 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 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 @ Home. Form 990, Part VI, Section C, line 19 The organization does not make its governing documents, conflict of interest policy, and financial statements available to the public. Form 990, Part XI, line 9: Equity Transfers 750,000. 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 at Home. Form 990, Part X, Line 20: Avera at Home is part of the Avera Obligated Group which consists of Avera Health, Avera McKennan, Avera St. Luke's, Avera Queen of Peace, Avera Sacred Heart, Avera Marshall, Avera St. Mary's, Avera St. Anthony's, Avera St. Benedict, Avera Holy Family, Avera Tyler, Avera Gettysburg and Avera at Home. Avera at Home was not allocated any share of the bond issue, and thus does not have an amount on line 20. Avera Home Medical Equipment LLC 1325 S Cliff Ave PO Box 5045 Sioux Falls SD 57117 460488198 Medical Services - Home Medical Equipment SD 19447948 8104720 Avera at Home Avera Health 3900 W Avera Drive Suite 300 Sioux Falls SD 57108 460422673 Healthcare Services SD 501(c)(3) Line 10 N/A 0 Sacred Heart Health Services 501 Summit Street Yankton SD 57078 460225483 Healthcare Services SD 501(c)(3) Line 3 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 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 North 8th Street Estherville IA 51334 420680370 Healthcare Services IA 501(c)(3) Line 3 Avera Health 0 Avera Holy Family Foundation 826 North 8th Street Estherville IA 51334 421317452 Support Health Related Services IA 501(c)(3) Line 10 Avera Holy Family 0 St Benedict Health Center 401 West Glynn Drive Parkston SD 57366 460226738 Healthcare Services SD 501(c)(3) Line 3 Avera Health 0 St Benedict Health Center Foundation West Glynn Drive PO Box B Parkston SD 57366 460458725 Support Health Related Services SD 501(c)(3) Line 12a, I St Benedict Health Center 0 Avera McKennan 1325 S Cliff Ave PO Box 5045 Sioux Falls SD 57117 460224743 Healthcare Services SD 501(c)(3) Line 3 Avera Health 0 Avera Queen of Peace Hospital 525 North Foster Mitchell SD 57301 460224604 Healthcare Services SD 501(c)(3) Line 3 Avera Health 0 Avera St Luke's 305 South State Street Aberdeen SD 57401 460224598 Healthcare Services SD 501(c)(3) Line 3 Avera Health 0 Avera Marshall 300 S Bruce St Marshall MN 56258 410919153 Healthcare Services MN 501(c)(3) Line 3 Avera Health 0 Avera Gettysburg 606 East Garfield Gettysburg SD 57442 460234354 Healthcare Services SD 501(c)(3) Line 3 Avera St Mary's 0 Avera St Mary's 801 East Sioux Avenue Pierre SD 57501 460230199 Healthcare Services SD 501(c)(3) Line 3 Avera Health 0 Avera Tyler 240 Willow Street Tyler MN 56178 410853163 Healthcare Services MN 501(c)(3) Line 3 Avera Marshall 0 Avera Health Plans Inc 3900 W Avera Drive Suite 101 Sioux Falls SD 57108 460451539 Health Financing and Health Plan Administration SD 501(c)(4) Avera Health 0 Heart Hospital of South Dakota LLC 4500 W 69th Street Sioux Falls SD 57108 562143771 Health care services SD N/A Avera Home Medical Equipment of Floyd Valley Hospital LLC 714 Lincoln St NE Lemars IA 51031 820582350 medical services - home medical equipment SD Avera at Home related 49419 193870 0 0 0.50000 Avera Home Medical Equipment of Sioux Center LLC 38 19th St SW Sioux Center IA 51250 753203100 medical services - home medical equipment SD Avera at Home related 34272 165682 0 0 0.50000 Q&M Properties LLC 525 North Foster Mitchell SD 57301 731652049 medical clinic building SD N/A Surgical Associates Endoscopy Clinic LLC 310 S Pennsylvania St Aberdeen SD 57401 460461429 surgical associates SD N/A Avera Home Medical Equipment of Spencer Hospital LLC 2400 S Minnesota Avenue 102 Sioux Falls SD 57117 800619999 medical services - home medical equipment SD Avera at Home related 92325 194517 0 0 0.50000 Brookings Health System - Avera HME LLC 101 22nd Ave Suite 101 Brookings SD 57006 453204123 Medical services - home medical equipment SD Avera at Home related 82886 264418 0 0 0.50000 National Rural ACO 4 LLC dba Prairie Hills Care 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 Valley Health Services 501 Summit Street Yankton SD 57078 460357149 rental real estate SD N/A C 0 Accounts Management Inc 5132 S Cliff Ave Ste 101 Sioux Falls SD 57108 460373021 collection agency SD N/A C 0 Avera Property Insurance Inc 610 W 23rd St Ste 1 PO Box 38 Yankton SD 57078 460463155 insurance 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 2600 W 49th Street Sioux Falls SD 57105 460401087 insurance SD N/A C 0 DakotaCare Administrative Services Inc 2600 W 49th Street Sioux Falls SD 57105 460424322 insurance SD N/A C 0 0 0 1 0 0 0 0 0 0 0 1 1 1 1 1 1 1 1 1