2017-05-15T11:34:53-05:00 2016-06-30 450250958 Eide Bailly LLP 800 Nicollet Mall Ste 1300 Minneapolis MN 554027033 990 2015-07-01 460399291 Avera at Home AVER 6053224597 5116 S Solberg Ave Sioux Falls SD 57108 Nichole Cody VP of Finance 6053224597 2017-05-11 1 Kim Hunwardsen CPA P00484560 6122536500 2017-05-11 2015 2021-01-29 14:40:06Z Sandra Dieleman 5116 S Solberg Ave Sioux Falls SD 57108 33644956 0 X None X 1987 SD Develop programs for community based services: Home Health, Hospice Care, & Home Medical Equipment. 13 4 451 175 129393 40959 181366 209587 16769562 33435369 0 0 0 0 16950928 33644956 0 0 0 0 12597029 20200064 0 0 0 6986582 15512536 19583611 35712600 -2632683 -2067644 4677911 13252277 10632180 3194752 -5954269 10057525 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 11163039 12036733 Avera at Home provides quality care in a patient's home. Home health care helps seniors, adults and pediatric patients who are recovering after a facility stay, or who need additional help to remain safe at home and to avoid unnecessary hospitalizations. Home care aims to make it possible for patients 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. There is a variety of medical and health-related items for purchase or rent. Individuals benefit from a 24/7 emergency call service as well as training in how to safely and effectively use medical equipment at home. With home medical equipment individuals can monitor their own health in the comfort of their home. 3922149 4012244 Avera at Home provides homemaker services to elderly and handicapped individuals in their homes. Homemaker care involves medical, social and related support services with the goal of providing care to ensure the activities of daily living are met. These services make it possible for individuals to remain living in their homes. 15085188 17386392 Avera at Home provides hospice care in the patient's home with quality, compassionate care for people facing a life-limiting illness or injury. Hospice care involves pain management, and emotional and spiritual support with a team approach and medical care team. Bereavement support is provided to the patient's loved ones as well. Avera at Home also provides residential and inpatient care hospice in a 16 bed facility in Sioux Falls, South Dakota. 30170376 1 1 0 0 0 0 0 0 0 0 1 0 0 0 0 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 37 0 1 451 1 1 1 0 0 0 0 0 0 0 0 0 X 13 4 0 0 0 0 1 1 1 1 0 0 0 1 1 1 1 1 1 0 1 0 X Nichole Cody 6053224763 5116 S Solberg Ave Sioux Falls SD 57108 Thomas Alan Clark Board Chair 0.50 40.00 X X 0 436913 41702 Curtis John Hohman Board Vice Chair 0.50 40.00 X X 0 312378 28732 Jamie Schaefer Secretary 0.50 40.00 X X 0 222150 17161 Tom Snyder Board Member 0.50 40.00 X 0 153449 1773 Dr Nanci J Van Peursem Board Member 0.50 40.00 X 0 248595 25729 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 149086 25744 Timothy Dougherty Board Member 0.50 0.00 X 0 0 0 Michael Knapp Board Member 0.50 40.00 X 0 248369 30932 Sister Debra Kolecka Board Member 0.50 6.00 X 0 0 0 Karen Sue Gallagher Board Member 0.50 40.00 X 0 114136 22597 Sandy Dieleman CEO 40.00 0.00 X X 0 258796 42398 Nichole Cody VP of Finance 40.00 0.00 X 115374 0 7886 Cindy Senger VP of Patient Care 40.00 0.00 X 137775 0 9332 Jean Hunhoff Regional Director 40.00 0.00 X 113501 0 22926 Rhonda Wiering Regional Director 40.00 0.00 X 110748 0 25565 477398 2143872 302477 4 0 1 0 Avera Health 3900 West Avera Drive Sioux Falls SD 57108 Shared Services 1297410 John Decker 46507 Lorraine Circle Harford SD 57013 Physical Therapy Services 200110 2 209587 209587 Patient revenue 624120 32316241 32217157 99084 HME partnerships revenue 624120 906507 876198 30309 212621 212621 33435369 33644956 33305976 129393 0 284154 284154 15365738 13531521 1834217 734642 619066 115576 2832640 2584213 248427 982890 845794 137096 11200 5400 5800 1769706 1564949 204757 63205 20113 43092 721364 691538 29826 300393 134712 165681 811483 726531 84952 860378 775690 84688 53415 12534 40881 168388 168388 1154472 1139472 15000 125621 74334 51287 Medical supplies 6429558 6429558 ACS fees 2042160 2042160 Bad Debt Expense 334965 334965 Food transfer 139255 138145 1110 526973 373453 153520 35712600 30170376 5542224 0 1340366 2478402 2235991 4080046 1070684 74302 89574 11679379 6822842 791834 4856537 601990 75044 235418 0 4677911 13252277 1853568 3194752 8350000 428612 0 10632180 3194752 X -5954269 10057525 -5954269 10057525 4677911 13252277 X -2067644 18079438 X X 0 1 X 1 0 X 183188 181366 209587 574141 651319 608757 10504096 16769562 33305976 61839710 651319 608757 10687284 16950928 33515563 62413851 0 70379 70379 70379 70379 62343472 497 787 1284 497 787 1284 129393 129393 651816 609544 10687284 16950928 33644956 62544528 0.99680 0.99740 0.00000 0.00010 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 4626400 2260290 2366110 369130 56413 312717 6683849 4506139 2177710 4856537 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 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 for consolidated subsidiaries are no longer subject to federal tax examinations by tax authorities for years before 2012. 0 0 0 0 0 0 0 0 0 Thomas Alan Clark Board Chair 0 346830 0 0 0 90083 0 18872 0 23625 0 479410 0 0 Curtis John Hohman Board Vice Chair 0 310753 0 0 0 1625 0 20900 0 8145 0 341423 0 0 Jamie Schaefer Secretary 0 221729 0 0 0 421 0 11384 0 5777 0 239311 0 0 Tom Snyder Board Member 0 152172 0 0 0 1277 0 0 0 2548 0 155997 0 0 Dr Nanci J Van Peursem Board Member 0 247828 0 0 0 767 0 5072 0 21432 0 275099 0 0 Doris Margaret Derynck Board Member 0 147757 0 0 0 1329 0 3083 0 23249 0 175418 0 0 Michael Knapp Board Member 0 247777 0 0 0 592 0 5185 0 26522 0 280076 0 0 Sandy Dieleman CEO 0 258620 0 0 0 176 0 19796 0 23194 0 301786 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 III, line 2 Home medical equipment 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 Directors; to fill vacancies on the Board of Directors, and to remove 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 11 The Form 990 is reviewed by the CEO and VP of Finance of Avera at Home. The return is provided to the Board of Directors 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, 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 is 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. The compensation of other officers, directors, and key employees is reviewed annually. The organization utilizes the resources of an outside independent agency for market comparability. The compensation is approved within the annual budget approved by the board. 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: Initial Equity HME 4,917,682. Equity Transfers 13,161,756. 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. Avera Home Medical Equipment LLC 1325 S Cliff Ave PO Box 5045 Sioux Falls SD 57117 460488198 Medical Services - Home Medical Equipment SD 14989365 6847659 Avera at Home Avera Health 3900 W Avera Drive Suite 300 Sioux Falls SD 57108 460422673 Healthcare Services SD 501(c)(3) Line 9 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 9 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 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 460458725 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 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 Marshall Foundation 300 S Bruce St Marshall MN 56258 411784801 Fundraising MN 501(c)(3) Line 7 Avera Marshall 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 Home related 22109 110298 0 0 0.50000 Avera Home Medical Equipment of Estherville LLC PO Box 5045 Sioux Falls SD 57117 201686097 medical services - home medical equipment SD Avera Home related 11748 0 2816 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 Home related 56282 156215 0 0 0.50000 Avera Home Medical Equipment of Marshall LLC 1104 East College Drive Marshall MN 56258 205271924 medical services - home medical equipment SD Avera Home related 87796 0 26842 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 Home related 60065 30834 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 Home related 134930 304643 0 651 0 0.50000 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 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 @ Home.