2019-05-14T15:29:28-05:00 2018-06-30 450250958 Eide Bailly LLP 800 Nicollet Mall Ste 1300 Minneapolis MN 554027033 990 2017-07-01 410919153 Avera Marshall AVER 5075329661 300 S Bruce Street Marshall MN 562581934 Jim Breckenridge CFO Avera Health 5075329661 2019-05-13 1 Kim Hunwardsen CPA P00484560 6122536500 2019-05-13 8.39.233.107 2019-05-13 10:01:50 CD P D8A1E5117AA53286D53F57459EBB2DE5C7CA50FC F9BEE9501A3B4F00F190E63700B8BF2BC70C7B96 2017 2019-02-21 02:37:17Z Avera Marshall Regional Medical Center Mary Maertens 300 S Bruce Street Marshall MN 562581934 89885558 0 X www.avera.org X 1944 MN Promotion of health 13 11 682 165 69075 47096 717156 298926 81799650 87407483 2831585 2048141 -80 65712 85348311 89820262 24000 24500 0 0 43299774 45382218 0 0 134048 37038455 39209206 80362229 84615924 4986082 5204338 90345905 92846576 22528832 21722496 67817073 71124080 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 73311804 24500 87376309 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, three 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, of which there were 2,580 patient discharges, 58,372 outpatient visits, 21 swing-bed days, 988 newborn patient days, 56,066 clinic visits, and 27,109 nursing home resident days. Following is a breakdown of these statistics by facility:Avera Marshall Hospital2,580 Acute patient discharges58,372 Outpatient visits21 Swing-bed patient days988 Newborn patient days56,066 Clinic visitsAvera Morningside Heights Care Center27,109 Long-term resident daysAvera 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 $602,296.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. 73311804 1 1 0 1 0 0 0 0 1 0 1 1 0 0 1 1 0 1 0 0 0 0 0 0 0 0 1 1 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 1 105 0 1 682 1 1 1 0 0 0 0 0 0 0 0 0 X 13 11 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 Roger Pabst OD Chair 1.30 1.30 X X 0 0 0 Joyce Strootman Vice Chair 1.30 1.30 X X 0 0 0 Todd Bock Director 1.30 1.30 X 0 0 0 Doug Olsem Director 1.30 1.30 X 0 0 0 Sr Joan Reichelt Director 1.30 3.30 X 0 0 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 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 1.30 X 0 0 0 Curtis Louwagie MD Director/Ophthalmologist 41.30 1.30 X 652783 0 42256 Mary B Maertens President & CEO 40.00 2.50 X X 0 410791 42256 Jim Breckenridge CFO Avera Health 0.10 39.90 X 0 887406 34116 Sharon Williams Sec/Treas & VP Finance 40.00 0.10 X 188237 0 34022 Vikram Chatrath MD Orthopedics & Surgery 40.00 0.00 X 926784 0 44993 Alain Desy MD Orthopedics & Surgery 40.00 0.00 X 679449 0 38410 Syed Hasan MD Family Medicine 40.00 0.00 X 567132 0 22589 Trent Carlson MD General Surgery 40.00 0.00 X 444629 0 34051 Enrico Ocampo MD Endocrinolgy 40.00 0.00 X 425731 0 26446 3884745 1298197 319139 60 0 1 0 Big Stone Therapies Inc 209 Waginston Ave Ortonville MN 56278 Therapy Services 2443686 Avera McKennan 1001 E 21st ST Ste 401 Sioux Falls SD 57105 Physicians and Anciliary 1914791 Avera Health 3900 W Avera Dr Ste 301 Sioux Falls SD 57105 Shared services 1366478 Huron Consulting Group Inc 550 W VanBuren St Chicago IL 60607 Medical Consulting Services 456566 Weatherby Locums Inc PO Box 792633 Dallas TX 75397 Locum Physicians 407801 18 159905 112264 26757 298926 Net Patient Service Revenue 622110 85691004 85691004 Pharmacy Revenue 900099 884485 884485 Cafeteria Revenue 900099 237640 237640 594354 525279 69075 87407483 287025 287025 91971 64160 27811 27811 27811 1762252 0 1136 1762252 -1136 1761116 1761116 Operating interest 900099 37901 37901 37901 89820262 87376309 69075 2075952 X 24500 24500 1114457 890031 224426 36271997 34801273 1376788 93936 1641018 1577132 62423 1463 4428046 4171496 248965 7585 1926700 1798818 121009 6873 96219 96219 36985 8310 28675 3740 3740 13078470 6642636 6435834 142 36 106 1146488 1034498 111086 904 206730 73670 133060 1213674 1033790 179884 597772 515510 76514 5748 28336 8434 19902 590383 590383 3702410 3579226 119771 3413 420199 232498 187701 Medical Supplies 13250990 13250990 Bad Debt Expense 1341398 1341398 Fees, Taxes and Surchar 1132117 327654 804463 2363153 1409521 939506 14126 84615924 73311804 11170072 134048 2859090 4078102 25910 87035 10847668 11989755 115000 2036802 2422611 1593727 1477659 89130190 57606895 30910942 31523295 38630733 40669743 546458 572625 51967 25751 2727608 0 90345905 92846576 5840931 5774529 15741608 15206910 8832 5408 937461 735649 22528832 21722496 X 65151068 67387418 2223601 3294258 442404 442404 67817073 71124080 90345905 92846576 X 5204338 546196 -2443527 X X 0 1 X 1 0 X 0 0 0 0 0 0 0 0 1 3740 3740 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 53205063 32719641 20485422 127407 50364 77043 32226950 23952208 8274742 2500001 884682 1615319 31523295 Interest in Avera Health Foundation 3798053 F Assets Limited to Use-Avera Pooled Investments 36871690 F 40669743 Estimated Third-Party Payor Settlements 735649 735649 X Part IV, Line 2b: The Organization holds funds on behalf of its residents. 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. 1 1 X 1 X 1 X 1 1 0 0 414123 414123 0.00500 6737412 5906354 831058 0.01000 7151535 5906354 1245181 0.01500 8485156 3166507 5318649 0.06390 8485156 3166507 5318649 0.06390 15636691 9072861 6563830 0.07890 1 1341398 0 21010958 21284468 -273510 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 15 1 0 1 1 X www.avera.org/marshall/ X See Part V, Page 8 X 1 15 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 and multiple community forums. In addition, Avera Marshall partnered with the Southwest Initiative Foundation, (SWIF) and the associated consultant services of Andrea Fox Jensen 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 Initiative Foundation Avera Marshall Part V, Section B, Line 11: The three priorities and goals identified from the CHNA assessment were:1) Mental Health a) Goal: Provide access to a full spectrum of mental health services. Provide a collaborative care model involving primary care, mid-level mental health professionals, and qualified community agencies.2) Eldercare and Memory Care Servicesa) Goal: Provide access to a full spectrum of Elder Care Services with partnerships with clinics, health providers, public health, employers, schools, civic leaders, police/fire and regional elder care services providers.3) Coordination of Carea) Goal: Optimize access and coordination of care throughout continuum and to accomplish shared goals within and across care setting through enhanced access to care services with a consistent care team approach.During FY 2018 the following items took place to help address the goals established in the prior year:1) Mental Health: a. Additional telemedicine resources provided for Behavioral healthb. Additional social worker added to the staff to support after hours behavioral health concerns and on call social worker created 24/7/365c. Consolidation of behavioral health transitions to social worker on calld. Recognized in efforts in Zero Suicide, a national effort to reduce suicide, standardize staff education, and consistently address means reduction with patientse. Won MHA patient safety award for zero suicide work. f. Partnerships with mental health agencies to provide mental health expertise in primary care area2) Eldercare and Memory Care Services:a. Additional resources added to support local schools with concussion management and healthy student choicesb. Recruitment of on staff chaplain (devote most of time in LTC and has Dementia groups)3) Coordination of Carea. Resources added to care coordination and collaboration of such with emergency servicesb. Recruitment of additional specialty physicians in cancer care, ENT, surgery, and primary care 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/ 6 1 - Avera Morningside Heights Care Center 300 S Bruce Street Marshall MN 56258 nursing home, adult daycare 2 - Avera Marshall SW 300 S Bruce Street Marshall MN 56258 optical 3 - AMG Optometry Redwood Falls 500 E Bridge Street Redwood Falls MN 56283 optometry, ophthalmology, optical 4 - AveraNow 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 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 on Line 7a was converted to cost using an overall cost-to-charge ratio addressing all patient segments. Unreimbursed Medicaid on line 7b was calculated using the costing methods to prepare the cost reports. The cost for subsidized health services reported on line 7g was determined using the Medicare Cost Report. Part I, Line 7g: Line 7g includes costs related to physician services of $8,485,156. Part I, Ln 7 Col(f): Bad debt expense of $1,341,398 is included on Form 990, Part IX, line 25, column (A) but excluded for purposes of calculating this percentage. Part III, Line 2: Bad debt expense is reported net of discounts and contractual allowances. A payment on an account previously written off reduces bad debt expense in the current year.Bad debt expense on line 2 is reported at charges as presented on the financial statements. Part III, Line 3: 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 III, Line 4: The footnote to the organization's financial statements that describes bad debt expenses can be found on page 10 of the attached audited financial statements. 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's service area includes Lyon County and surrounding counties in Minnesota. In 2016, the population for Lyon County was estimated to be 25,699. Approximately 15% of the population is age 65 or older. The average per capita income is $28,860 and approximately 12.8% of individuals are below the federal poverty level. The nearest hospital in the area is approximately 22 miles from Avera Marshall. 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 Medical Student Scholarships 4 24000 Part I, Line 2: The Organization provides scholarships to medical students. The Organization monitors the use of the scholarships through a recruiter who maintains contact with the students and monitors receipt of the scholarship by the learning institution. 0 0 0 0 0 0 0 0 0 Curtis Louwagie MD Director/Ophthalmologist 633533 0 17040 0 2210 0 13500 0 28756 0 695039 0 0 0 Mary B Maertens President & CEO 0 312808 0 0 0 97983 0 13500 0 28756 0 453047 0 0 Jim Breckenridge CFO Avera Health 0 815781 0 0 0 71625 0 13500 0 20616 0 921522 0 0 Sharon Williams Sec/Treas & VP Finance 169936 0 0 0 18301 0 9158 0 24864 0 222259 0 0 0 Vikram Chatrath MD Orthopedics & Surgery 762227 0 119722 0 44835 0 13500 0 31493 0 971777 0 0 0 Alain Desy MD Orthopedics & Surgery 620812 0 12450 0 46187 0 13500 0 24910 0 717859 0 0 0 Syed Hasan MD Family Medicine 327205 0 212142 0 27785 0 13500 0 9089 0 589721 0 0 0 Trent Carlson MD General Surgery 400470 0 9918 0 34241 0 13500 0 20551 0 478680 0 0 0 Enrico Ocampo MD Endocrinolgy 400690 0 22500 0 2541 0 13500 0 12946 0 452177 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 and Mary Maertens 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 1,971,614. Management and general expenses 203,446. Fundraising expenses 0. Total expenses 2,175,060. Purchased Services: Program service expenses 4,671,022. Management and general expenses 348,776. Fundraising expenses 0. Total expenses 5,019,798. ACS Fees: Program service expenses 0. Management and general expenses 5,883,612. Fundraising expenses 0. Total expenses 5,883,612. Form 990, Part XI, line 9: Equity transfer to related parties -3,050,378. Net assets released from restrictions -578,158. Other change in net assets held by Avera Health Foundation 1,146,953. Change in Interest in Avera Foundation 38,056. 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 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 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 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 610 W 23rd St PO Box 38 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 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 1 1 0 1 0 0 1 0 1 1 1 1 1 1 1 1 1 1 1 Avera Tyler D 299747 General Ledger Avera Tyler S 450000 General Ledger Avera Tyler O 1792582 General Ledger