2017-05-15T10:46:43-05:00 2016-06-30 450250958 Eide Bailly LLP 800 Nicollet Mall Ste 1300 Minneapolis MN 554027033 990 2015-07-01 410919153 Avera Marshall AVER 5075329661 300 S Bruce Street Marshall MN 562581934 Mary Maertens President and CEO 5075329661 2017-05-12 1 Kim Hunwardsen CPA P00484560 6122536500 2017-05-12 2015 2021-01-29 14:40:06Z Avera Marshall Regional Medical Center Mary Maertens 300 S Bruce Street Marshall MN 562581934 80319781 0 X www.avera.org X 1944 MN Promotion of health 16 12 631 154 80234 50789 6236684 1463697 71576865 78154416 774848 546608 -62884 96426 78525513 80261147 33185 1037971 0 0 36391805 40082385 0 0 164607 33717021 36738386 70142011 77858742 8383502 2402405 81356490 87053246 22819848 23727761 58536642 63325485 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. 1 0 40916413 1037971 53407861 Avera Marshall (dba Avera Marshall Regional Medical Center) is a non-profit organization, affiliated with Avera Health. Avera Marshall consists of a 25-bed Critical Access Hospital, an attached 76-bed nursing home, a cancer center, three physician clinics, and six optometry clinics. The physician clinics include specialty services (primary care, ob/gyn, pediatrics, orthopedics, general surgery, podiatry and internal medicine), psychiatry services, radiation oncology and ophthalmology services. In fiscal year 2016, Avera Marshall had 3,904 patient days in addition to 908 newborn patient days, 267 swing-bed days, and 2,628 behavioral-health bed days.Avera Marshall is a Level III trauma center for emergency services.AWARDS AND RECOGNITIONCompleted Catholic Identity Matrix for the first time.Completed Community Health Needs Assessment for the second time in Avera Marshall history.Blue ribbon in Minnesota Department of Health Flu Safe program for 99 percent of employees receiving flu vaccination. STRATEGIC ACCOMPLISHMENTSManagement agreements - Avera Marshall has a "Partner in Health Agreement" with other non-profit organizations, which include Divine Providence Health Center in Ivanhoe, MN and Western Mental Health Center in Marshall, MN.Partnerships - Avera Marshall has a partnership arrangement for therapy services with Big Stone Therapies, Inc., to offer hospital and long term care based services to inpatients and outpatients. Enhanced sleep lab services.. This included installing state-of-the-art diagnostic equipment, updated rooms and partnered with Avera McKennan for performing tests and reading results. Brought cancer care closer to home for people in the Marshall region. Before opening Avera Cancer Institute Marshall, infusion visits (chemotherapy) averaged 80-100 treatments per month. June 2016 reached nearly 200 treatments. 1,901 radiation treatments were provided in fiscal year 2016 with 83 new patients treated.There were 537 deliveries in fiscal year 2016. This was the fourth consecutive year births increased. 5924530 6029566 AWARDS AND RECOGNITIONAvera Morningside Heights earned the Avera Caring with Safety Award for work in reducing falls and ensuring safety of residents. Award was presented at the 13th annual Avera quality Congress.STRATEGIC ACCOMPLISHMENTSAvera Morningside Heights Care Center repeatedly admits high acuity and behaviorally challenged residents that other care facilities in the region and beyond will not accept for care.Adult day care, cares for clients with all stages of dementia which provides caregiver relief/respite and allows individuals the ability to remain in their home/community. 19939382 18660758 AWARDS AND RECOGNITIONBridges to Excellence Award Avera Medical Group Marshall recognized for improving care delivery and patient outcomes as part of the Minnesota Bridge to Excellence program. The program requirements were met by within the improvement goal for diabetes care.STRATEGIC ACCOMPLISHMENTSAvera Medical Group Southwest Ophthalmology and Avera Medical Group Optometry locations went live with a new electronic medical record specific to ophthalmology and optometry services. Avera Marshall purchased a dental practice from a private dentist in June 2016 to add dentistry to our services we offer. Avera Medical Group Marshall received recertification as a medical home.As of June 30, 2016, Avera Marshall clinics had 54 clinical providers as compared to zero in 2008 when Avera Marshall first entered the clinic business. There were an additional 12 providers who joined Avera Marshall during the fiscal year ending June 30, 2016.The following is a list of services and locations:* Marshall - Psychiatry, Mental Health Therapy, Ophthalmology, Optometry, Obstetrics, Gynecology, Orthopedics, Sports Medicine, General Surgery, Podiatry, Family Medicine, Internal Medicine, Pediatrics* In-reach in Marshall - Allergy/Asthma, Cardiology, Neurology, ENT, Urology, Medical Oncology, Maternal Fetal Medicine, Nephrology, Pediatric Cardiology* Ophthalmology Outreach - Redwood Falls, Springfield, Montevideo, Granite Falls* Optometry Locations outside of Marshall - Springfield, Tracy, Redwood Falls* OB/GYN Outreach - Dawson, Tyler, Redwood Falls, Slayton* Podiatry - Marshall Assisted Living Locations (Boulder Estates, Boulder Creek, Heritage Point), Redwood Falls (Clinic and Garnette Gardens), Hendricks, and Ivanhoe* General Surgery Outreach - Westbrook, Tracy* Orthopedics Outreach - Springfield 66780325 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 1 1 1 0 0 0 1 0 0 1 0 0 0 0 0 0 1 1 1 0 0 1 93 0 1 631 1 1 1 0 0 0 0 0 0 0 0 0 X 16 12 1 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 0 1 1 0 MN X Sharon Williams 5075379150 300 S Bruce St Marshall MN 562581934 Roger Pabst OD Chair/Provider 15.30 1.30 X X 59087 0 8668 Joyce Strootman Vice Chair 1.30 1.30 X X 0 0 0 Todd Bock Director 1.30 1.30 X 0 0 0 James H Fuhrmann Director 1.30 1.30 X 0 0 0 Donna Hartfiel MD Director/Physician 41.30 1.30 X 0 139612 6003 Sr Carmella Luke Director 1.30 1.30 X 0 0 0 Doug Olsen Director 1.30 1.30 X 0 0 0 Randy Gaffney Director 1.50 1.30 X 0 0 0 Sr Mary J Reichelt Director 1.30 4.50 X 0 0 0 Michael K Rich Director 1.30 1.30 X 0 0 0 Sr Roxanne Seifert Director 1.30 40.00 X 0 0 0 Randy Serreyn Director 1.50 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 Mary B Maertens President & CEO 40.00 2.50 X X 0 356945 43314 Sharon Williams Sec/Treas & VP Finance 40.00 0.10 X 167817 0 26789 Curtis Louwagie MD Physician 40.00 0.00 X 658233 0 26732 Vikram Chatrath MD Physician 40.00 0.00 X 799867 0 28532 Traci Kruse MD Physician 40.00 0.00 X 427497 0 5300 Ajay Shalwala MD Physician 40.00 0.00 X 493186 0 11390 Syed Hasan MD Physician 40.00 0.00 X 571502 0 13284 3177189 496557 170012 49 0 1 0 Avera Health 3900 W Avera Dr Ste 301 Sioux Falls SD 57105 Shared services 7095846 Avera McKennan 1001 E 21st ST Ste 401 Sioux Falls SD 57105 Physicians and Anciliary 2427352 Big Stone Therapies Inc 209 Waginston Ave Ortonville MN 56278 Therapy Services 2143439 Weatherby Locums Inc PO Box 977633 Dallas TX 75397 Locum physicians 817102 Stinson Leonard Street LLP PO Box 843052 Kansas City MO 64184 Legal services 637751 14 1167024 254206 42467 1463697 Net Patient Service Revenue 622110 75220589 75220589 Pharmacy Revenue 900099 1346406 1346406 Meaningful Use Revenue 900099 438714 438714 Gain on Auxiliary 900099 272096 272096 Equity Earnings of Affiliated Org 900099 209224 182382 26842 667387 613995 53392 78154416 552267 552267 125398 52975 72423 72423 72423 5659 -5659 -5659 -5659 Operating interest 900099 24003 24003 24003 80261147 78098185 80234 619031 X 1000000 1000000 37971 37971 236373 38077 198296 115883 115883 31776387 29964298 1707201 104888 1729603 1582652 141100 5851 4397311 4006058 373945 17308 1826828 1669383 150154 7291 339182 339147 35 17289 10204 7085 3193 3193 10019433 6159557 3859876 1633 1633 981932 871863 109420 649 2023868 32554 1991314 1281584 1109153 172431 494355 456816 34864 2675 23040 8339 14701 556542 556542 3953448 3733682 215658 4108 365933 187243 178690 Medical Supplies 10667394 10666842 552 Fees, Taxes and Surchar 2085412 853937 1231475 Bad Debt Expense 1885523 1885523 Provision for income ta 33610 33610 2005015 1796945 186268 21802 77858742 66780325 10913810 164607 3995270 6209015 463374 9670159 12412487 130000 204583 1948868 1960415 1384481 1351896 84952820 51879194 35665953 33073626 27071202 30570102 1179542 393632 311015 414116 81356490 87053246 5196284 5655726 16519555 16257452 6466 5730 1097543 1808853 22819848 23727761 X 58536642 61015359 1868099 442027 58536642 63325485 81356490 87053246 X 2402405 -505501 2891939 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 3193 3193 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 536512 536512 51778897 28848438 22930459 216918 67743 149175 30107087 21859331 8247756 2313406 1103682 1209724 33073626 Investment in Affiliated Organizations 3791211 F Assets Limited to Use-Avera Pooled Investments 26778891 F 30570102 Estimated Third-Party Payor Settlements 1808853 1808853 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 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 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 subisidiary returns for consolidated subsidiaries are no longer subject to federal tax examinations by tax authorities for years before 2013. 1 1 X 1 X 1 X 1 1 1 0 1 1 318650 318650 0.00420 5804569 4660043 1144526 0.01510 6123219 4660043 1463176 0.01930 6512384 2600987 3911397 0.05150 6512384 2600987 3911397 0.05150 12635603 7261030 5374573 0.07080 1 1885523 0 19158124 19273466 -115342 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 8 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 7 X 1 15 1 See Part V, Page 7 0 0 1 X 150.000000000000 400.000000000000 X X X X 1 1 X X X 1 X http://www.avera.org/experience/ah/financial-assistance-charity-care/ X http://www.avera.org/experience/ah/financial-assistance-charity-care/ X http://www.avera.org/experience/ah/financial-assistance-charity-care/ X X X X X X 1 X 0 X X X X X 1 X 0 1 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 have been 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.Actions were not taken as of June 30, 2016 due to the timing of the completion of the Implementation Strategy. These will be addressed beginning FY 2017. 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 16i: 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 22d: The hospital facility calculated the amount generally billed under the look-back method using the lowest inpatient and outpatient combined Medicare and commercial payment rate. This rate will be reviewed and updated on an annual basis each October. Avera Marshall Part V, Section B, Line 24: Individuals eligible for financial assistance are not charged gross charges for emergency or other medically necessary care; however may be charged gross charges for elective care. Schedule H, Part V, Section B, Line 7b: http://www.avera.org/experience/shared/community-needs-health-assessments/ Schedule H, Part V, Section B, Line 10a: http://www.avera.org/experience/shared/community-needs-health-assessments/ 6 1 - Avera Morningside Heights Care Center 300 S Bruce Street Marshall MN 56258 nursing home, adult daycare 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 - AMG Optometry Windom 1006 4th Avenue Windom MN 56101 optometry, ophthalmology, optical 6 - Avera Marshall Curaquick 900 E Main Street Marshall MN 56258 convenience clinic 7 - AMG Optometry Tracy 505 State Street Tracy MN 56175 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 6a: The Avera Marshall community benefit report is contained within a report prepared by Avera Health, a related organization. It is available through the website and requested mailing, and is filed with the Catholic Health Association. 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, Ln 7 Col(f): The bad debt expense included on Form 990, Part IX, Line 25, Column (A), but subtracted for purposes of calculating the percentage in this column is $1,885,523. Part II, Community Building Activities: The amounts reported as community building include monetary and in-kind donations to community organizations to support the needs of the community beyond the need for healthcare. Avera Marshall's employees and management also volunteer and participate in area community organizations. These organizations include non-profit and civic organizations. Avera Marshall also encourages middle-school aged students to consider a career in healthcare through their Scrubs Camp which is a one-day program. These contributions strengthen the community by focusing on underlying causes of health care issues. 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 is reported at charges as recorded by the organization. Part III, Line 3: Avera Marshall does not believe that any portion of bad debt expense could reasonably be attributed to patients who may qualify for financial assistance since evaluations are completed to determine those amounts due and will be reclassified from bad debt expense to charity care within 30 days of the evaluation of the amount. 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: 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. 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 2015, the population for Lyon County was estimated to be 25,673. Approximately 14.8% of the population is age 65 or older. The average per capita income is $28,010 and approximately 12.2% 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 Curaquick 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 (weekly free meal 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 separate exempt organization, 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. 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: The communities in which Avera operates all have unique health and community benefit needs and in keeping with the Catholic Healthcare Association guidelines each hospital strives to meet its community's identified needs. The Avera central office advocates for all on community benefit related matters of state, regional and national importance. 1 City of Marshall 344 West Main Street Marshall MN 56258 416005351 City of Marshall 1000000 Community benefit 1 0 LTC Nursing Scholarships 9 13569 LTC Adult Day Care Scholarship 1 402 Medical Student Scholarships 4 24000 Part I, Line 2: The Organization provides scholarships to medical students, long-term care employees and a stipend to SIM (Student Internship in Medicine) students. The Organization monitors the use of the scholarships through a recruiter who maintains contact with the students, and monitors receipt of the employee scholarship by the learning institution. 0 0 0 0 0 0 0 0 0 Mary B Maertens President & CEO 0 294295 0 0 0 62650 0 19332 0 24659 0 400936 0 0 Sharon Williams Sec/Treas & VP Finance 167021 0 0 0 796 0 3384 0 24046 0 195247 0 0 0 Curtis Louwagie MD Physician 656807 0 0 0 1426 0 5300 0 23610 0 687143 0 0 0 Vikram Chatrath MD Physician 798754 0 0 0 1113 0 5300 0 25143 0 830310 0 0 0 Traci Kruse MD Physician 426824 0 0 0 673 0 5300 0 1150 0 433947 0 0 0 Ajay Shalwala MD Physician 492369 0 0 0 817 0 3125 0 9805 0 506116 0 0 0 Syed Hasan MD Physician 570930 0 0 0 572 0 5019 0 9369 0 585890 0 0 0 Schedule J, Part I, Line 3: The President & CEO was 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. Dr Vikram Chatrath Employee Community needs loan X 200000 90000 0 0 1 Dr Syed Mustafa Hasan Employee Community needs loan X 100000 52083 0 0 1 Dr Traci Kruse Employee Community needs loan X 250000 10417 0 0 1 Dr Ajay Shalwala Employee Community needs loan X 100000 52083 0 0 1 204583 Melissa Younger Family member of board member, Randy Serreyn 115883 Employee compensation 0 Form 990, Part III, line 2 Avera Marshall assumed ownership of Tyler HealthCare Center on March 1, 2016 which became a wholly owned subsidiary of Avera Marshall and was renamed Avera Tyler. Avera Tyler remains its own corporation and files its own 990. Avera Tyler is a 21-bed hospital, a 38-bed skilled nursing facility, and has rural health clinics in Tyler and Lake Benton Minnesota. Inpatient, outpatient and long term care services are provided to the residents of Lincoln, Pipestone and Lyon counties in southwest Minnesota. Some staff from Avera Marshall and Avera Tyler have been regionalized to improve the financial operations of both facilities. Avera Cancer Institute Marshall began hosting quarterly Look Good Feel Better sessions. This is a workshop from the American Cancer Society to help women experiencing hair loss and skin changes resulting from chemotherapy and radiation treatment. Held first annual Gathering of Hope and Healing at Avera Cancer Institute Marshall (ACIM) to honor and celebrate lives of patients who received care at ACIM. ACIM treated its first patients in January 2015. Purchased Tyler Dental Care and renamed it Avera Medical Group Dental Care to preserve local access to dental care which is in short supply in the region. Added social worker to clinic care model at Avera Medical Group Marshall to provide care for patients presenting in primary care with urgent behavioral health care needs. Began utilizing telemedicine through Avera eCARE to keep patients close to home for behavioral health care. 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 Donna Hartfiel, MD has a business relationship with Sr. Mary J. Reichelt. Mary Maertens has a business relationship with Sr. Mary J. Reichelt. Roger Pabst, OD has a business relationship with Mary Maertens. 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 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 11 The Form 990 is reviewed initially by the CEO and CFO, then the Finance Committee. The return is provided to the Board of Directors for review prior to filing. 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 Mary Maertens was compensated by Avera Health for services provided to Avera Marshall and Avera Marshall Foundation. There is a compensation committee of the Avera Health Board of Directors that does review the top 22 employees after Integrated Health Strategies (consultant) reviews and makes recommendations. A full review of benefits and salary is done every other year with a compensation review done on the other year. All decisions are based on comparable data for fair market analysis of like positions. Sharon Williams is compensated by Avera Marshall. Her position is reviewed annually, targeting the 50th percentile of the market for comparable positions in similarly sized healthcare facilities in the US, particularly in the north central region. 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 1,447,253. Management and general expenses 167,280. Fundraising expenses 0. Total expenses 1,614,533. Purchased Services: Program service expenses 4,712,304. Management and general expenses 1,583,614. Fundraising expenses 0. Total expenses 6,295,918. ACS Fees: Program service expenses 0. Management and general expenses 1,444,094. Fundraising expenses 0. Total expenses 1,444,094. Recruitment: Program service expenses 0. Management and general expenses 664,888. Fundraising expenses 0. Total expenses 664,888. Form 990, Part XI, line 9: Net assets received in affiliation 286,042. Equity transfer to related parties -675,734. Avera Marshall Foundation net assets 3,748,683. Other adjustment -467,052. 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, and Avera St. Mary's. In accordance with IRS instructions, information related to the tax exempt bond reporting is being reported on Avera Health's tax return. 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 Holy Family Hospital and Home Health Agency IA 501(c)(3) Line 9 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 Health Related Services SD 501(c)(3) Line 11a, 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 9 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 9 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 11b, II Avera Health 0 Avera Health 3900 West Avera Drive Suite 300 Sioux Falls SD 57108 460422673 Healthcare Services SD 501(c)(3) Line 9 N/A 0 Avera Marshall Foundation 300 S Bruce Street Marshall MN 56258 411784801 Fundraising MN 501(c)(3) Line 7 Avera Marshall 1 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 Estherville LLC PO Box 5045 Sioux Falls SD 57117 201686097 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 Avera Home Medical Equipment of Marshall LLC 1104 East College Drive Marshall MN 56258 205271924 Medical Services - Home Medical Equipment SD Avera at Home Related 87796 0 0 0.50000 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 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 0 0 1 0 0 0 0 0 0 1 1 1 1 1 1 1 1 1 1 Avera Marshall Foundation C 1167024 General ledger Avera Marshall Foundation S 3748683 FMV of assets from dissolution Schedule R, Part II: Effective October 1, 2015, Avera Health Plans Inc. obtained tax exempt status under IRC 501(c)(4). Avera Health Plans Inc. was previously taxed as a C-corporation. Effective March 1, 2016, Avera Tyler was acquired by Avera Health. Schedule R, Part III: Avera Home Medical Equipment of Estherville, LLC dissolved effective October 1, 2015. Avera Home Medical Equipment of Marshall, LLC dissolved effective January 1, 2016. Operations of both entities were transferred to Avera at Home.