2016-11-15T11:52:04-06:00 2015-12-31 450250958 EIDE BAILLY LLP 200 EAST 10TH ST PO BOX 5125 SIOUX FALLS SD 571175125 990 2015-10-01 460451539 AVERA HEALTH PLANS INC AVER 6053224500 3816 S ELMWOOD AVE STE 100 SIOUX FALLS SD 57105 ROBIN O BATES PRESIDENT 6053224500 2016-11-15 1 LAURIE HANSON P00851848 6053391999 2016-11-15 2015 2017-02-10 21:41:12Z X ROBIN O BATES 3816 S ELMWOOD AVE STE 100 SIOUX FALLS SD 57105 40987392 0 X AVERAHEALTHPLANS.COM X 1999 SD TO MAKE A POSITIVE IMPACT IN THE LIVES AND HEALTH OF PERSONS AND COMMUNITIES. 10 4 141 12 549367 -102203 0 40745036 214830 1078 40960944 0 0 2110667 0 0 51912283 54022950 -13062006 47717458 25610599 22106859 X TO MAKE A POSITIVE IMPACT IN THE LIVES AND HEALTH OF PERSONS AND COMMUNITIES BY PROVIDING QUALITY SERVICES GUIDED BY CHRISTIAN VALUES. 0 0 50712592 40196747 AS AN ESSENTIAL COMPONENT OF THE AVERA HEALTH INTEGRATED DELIVERY SYSTEM, AVERA HEALTH PLANS (AHP) PROVIDES LOW-COST, HIGH QUALITY HEALTH PLAN COVERAGE AND CONDUCTS OTHER ACTIVITIES THAT INCREASE THE HEALTH OF THE COMMUNITY IN ITS SERVICE AREA. AHP CONDUCTS SUBSTANITALLY ALL OF ITS ACTIVITIES WITHIN THE SERVICE AREA OF AVERA HEALTH, BUT DOES CONDUCT A SMALL PORTION BEYOND THE AVERA HEALTH SERVICE AREA TO FULFILL ITS MISSION OF MAKING A POSITIVE IMPACT IN THE COMMUNITIES IT SERVES BY ENSURING ADEQUATE RURAL HEALTH CARE IS AVAILABLE. AHP PROVIDES HEALTH INSURANCE COVERAGE TO AN UNDERSERVED POPULATION INCLUDING ELDERLY AND LOW INCOME, HIGH RISK AND MEDICALLY UNDERSERVED PERSONS. OF THE 70,000 TOTAL MEMBERS IN 2015, 9,067 OF THESE MEMBERS WERE MEDICARE SUPPLEMENT MEMBERS AND APPROXIMATELY 69% CONSISTS OF INDIVIDUALS OR EMPLOYEES OF SMALL GROUPS. APPROXIMATELY 27,000 MEMBERS ARE INDIVIDUALS AND MORE THAN 85% OF THE ENROLLEES IN THE INDIVIDUAL CATEGORY WERE ELIGIBLE TO RECEIVE AN ADVANCE PREMIUM TAX CREDIT, WHICH MEANS THEY WERE BELOW 400% OF THE FEDERAL POVERTY LIMIT. AVERA HEALTH PLANS IS FURTHER DISTINGUISHED FROM THE FOR-PROFIT PLANS BY ITS PARTICIPATION IN THE FEDERAL HEALTH INSURANCE EXCHANGE/MARKETPLACE. AHP HAS AFFORDABLE, COMMUNITY-RATED PREMIUMS WHICH ARE BELOW MARKET, AND THEY DO NOT COVER AHP'S COSTS. NET MEDICAL AND PHARMACY CLAIMS EXPENSE RESULTED IN A MEDICAL INCOME RATIO (MLR) OF AN AVERAGE OF 103.3% FOR 2015. SIGNIFICANT FINANCIAL SUPPORT BY AVERA HEALTH (501(C)(3)) ALLOWS AHP TO REMAIN FINANCIALLY VIABLE.IN ADDITION TO PROVIDING LOW-COST INSURANCE COVERAGE, AHP CONDUCTS FREE MEDICAL SCREENINGS AT THE LOCATION OF ITS EMPLOYER GROUPS FOR THE BENEFIT OF ALL EMPLOYEES, REGARDLESS OF WHETHER THEY ARE ENROLLED IN AHP PLANS. AHP ALSO SPONSORS HEALTH EDUCATION OPEN FORUMS, OPEN HOUSES, AND WEBINARS THAT ARE OPEN TO THE PUBLIC. 50712592 0 0 0 0 0 0 0 0 0 1 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 1 0 0 0 0 0 1 0 0 1 2573 0 1 141 1 1 1 0 0 0 0 0 0 0 0 0 X 10 4 0 0 0 0 1 1 1 1 0 0 0 1 1 1 1 1 1 1 1 0 X CHRISTOPHER JESSEN CFO 6053224500 3816 S ELMWOOD AVE SIOUX FALLS SD 57105 ROB BATES PRESIDENT 4.00 40.00 X X 0 427862 36447 DR DAVE KAPASKA VICE PRESIDENT 1.00 40.00 X X 0 853345 39030 JIM BRECKENRIDGE SECRETARY 2.00 40.00 X X 0 777186 22921 DAVE TIMPE DIRECTOR 1.00 0.00 X 0 0 0 DR THOMAS DEAN DIRECTOR 1.00 0.00 X 0 0 0 JOHN PORTER DIRECTOR 1.00 40.00 X 0 1536437 36280 DR CLARK LIKNESS DIRECTOR 1.00 0.00 X 0 0 0 FRED SLUNECKA DIRECTOR 1.00 40.00 X 0 1106960 34150 GARY GASPER DIRECTOR 2.00 0.00 X 0 0 0 MARTY HITZMANN DIRECTOR 0.50 0.00 X 0 0 0 DEBRA MULLER CAO 40.00 0.00 X 191578 0 22965 DR PRESTON RENSHAW CMO 40.00 0.00 X 305543 0 36068 JAMES BRADLEY DIRECTOR OF SALES 40.00 0.00 X 167595 0 23088 CHRISTINE LOUNSBERY HEALTH SERVICES/PHARMACY MANAGER 40.00 0.00 X 134354 0 28048 PAM SKALS SALES ASSOCIATE 40.00 0.00 X 164961 0 31325 DAN PETERSON SALES ASSOCIATE 40.00 0.00 X 154444 0 16589 MIKE DOOLEY DIRECTOR OF PROVIDER CONTRACTING & ENGAGEMENT 40.00 0.00 X 123033 0 31061 1241508 4701790 357972 12 0 1 0 NATIONAL PHARMACEUTICAL SERVICES PO BOX 407 BOYS TOWN NE 68010 PHARMACY SERVICES 27086785 DUBRASKI & ASSOCIATES 11622 EL CAMINO REAL SUITE 100 SAN DIEGO CA 92130 REINSURANCE 3631128 ALERE PO BOX 403393 ATLANTA GA 303843393 DISEASE MANAGEMENT 1291898 MUTUAL MED 4321 E 60TH ST DAVENPORT IA 52807 BROKER COMMISSIONS 1006675 DST 13804 COLLECTION CENTER DR CHICAGO IL 60693 SOFTWARE SUPPORT SERVICES 823466 30 PREMIUM INCOME 524114 28044252 27494885 549367 REINSURANCE RECOVERIES 524114 4755718 4755718 COST CONTAINMENT ALLOCATIONS 900099 4145975 4145975 REIMBURSEMENTS BY UNINSURED PLANS 900099 3641606 3641606 COB AND SUBROGATION 900099 144700 144700 12785 12785 40745036 241278 241278 26448 -26448 -26448 -26448 OTHER INCOME 900099 1078 1078 1078 40960944 40196747 549367 214830 135173 66654 68519 1541721 980709 561012 23453 15464 7989 410320 256477 153843 6249 6249 68508 68508 41200 41200 1003260 688490 314770 1245255 52553 1192702 17945 17945 36550 36550 87648 14607 73041 47108 30904 16204 6331 1536 4795 21432 21432 20380 20380 HOSPITAL AND MEDICAL 41156402 41156402 CLAIMS ADJUSTMENT EXPEN 4815296 4815296 PREMIUM DEFICIENCY RESE 2502620 2502620 TAXES 646860 646860 189239 109448 79791 54022950 50712592 3310358 0 6983845 329008 308811 0 20197 14741588 0 25971828 0 47717458 3945830 0 21664769 0 25610599 X 0 100 0 59079053 0 -36972294 0 22106859 0 47717458 X -13062006 -98545 35267410 X 0 0 0 329008 308811 20197 20197 PREMIUMS PAID AND UNPAID 334279 ACCRUED INTEREST RECEIVABLE 98087 REINSURANCE RECEIVABLE 7228151 AMOUNTS DUE FROM AFFILIATES 18307928 RECEIVABLES RELATING TO UNINSURED PLANS 3383 25971828 ESTIMATED INCOMPLETE AND UNREPORTED 13004068 UNPAID CLAMS ADJUSTMENT 410000 AGGREGATE HEALTH POLICY RESERVE 2502620 PREMIUMS RECEIVED IN ADVANCE 5729144 PAYABLE TO PARENT, SUBSIDIARIES AND AFFILIATES 18937 21664769 X X 0 0 0 0 0 0 0 0 0 ROB BATES PRESIDENT 0 343214 0 0 0 84648 0 13617 0 23611 0 465090 0 0 DR DAVE KAPASKA VICE PRESIDENT 0 660694 0 0 0 192651 0 18750 0 21775 0 893870 0 0 JIM BRECKENRIDGE SECRETARY 0 606456 0 0 0 170730 0 13450 0 10834 0 801470 0 0 JOHN PORTER DIRECTOR 0 1189657 0 0 0 346780 0 13450 0 24426 0 1574313 0 0 FRED SLUNECKA DIRECTOR 0 863910 0 0 0 243050 0 13450 0 22296 0 1142706 0 0 DEBRA MULLER CAO 191309 0 0 0 269 0 8946 0 14463 0 214987 0 0 0 DR PRESTON RENSHAW CMO 305426 0 0 0 117 0 14636 0 22131 0 342310 0 0 0 JAMES BRADLEY DIRECTOR OF SALES 167092 0 0 0 503 0 1212 0 22196 0 191003 0 0 0 CHRISTINE LOUNSBERY HEALTH SERVICES/PHARMACY MANAGER 134237 0 0 0 117 0 7090 0 21279 0 162723 0 0 0 PAM SKALS SALES ASSOCIATE 164871 0 0 0 90 0 8625 0 22791 0 196377 0 0 0 DAN PETERSON SALES ASSOCIATE 154351 0 0 0 93 0 7553 0 9106 0 171103 0 0 0 MIKE DOOLEY DIRECTOR OF PROVIDER CONTRACTING & E 122857 0 0 0 176 0 6635 0 24722 0 154390 0 0 0 BROWN CLINIC ENTITY OWNED MORE THAN 35% BY BOARD MEMBER, DR. LIKNESS 215413 AVERA HEALTH PLANS PAID CLAIMS TO THE CLINIC. 0 FORM 990, PART IV, LINE 12A & 12B & FORM 990, PART XII, LINE 2B AN AUDIT WAS CONDUCTED FOR THE ENTIRE 2015 CALENDAR YEAR, PART OF WHICH WAS TAXABLE. AVERA HEALTH PLANS IS ALSO INCLUDED IN THE CONSOLIDATED AUDIT REPORT OF THEIR PARENT COMPANY, AVERA HEALTH. FORM 990, PART VI, SECTION A, LINE 6 THE SOLE SHAREHOLDER 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 SHAREHOLDER HAS THE RIGHT TO APPOINT AND REMOVE MEMBERS OF THE BOARD. FORM 990, PART VI, SECTION A, LINE 7B AVERA HEALTH AS THE SOLE SHAREHOLDER HAS THE POWER AT ALL TIMES TO CONDUCT BUSINESS WITH RESPECT TO THE CORPORATION. FORM 990, PART VI, SECTION A, LINE 8B THERE IS NO COMMITTEE WITH AUTHORITY TO ACT ON BEHALF OF THE BOARD. FORM 990, PART VI, SECTION B, LINE 11 THE CFO WILL REVIEW THE FORM 990 IN DEPTH. UPON THE CFO'S COMPLETED REVIEW, A DRAFT OF THE FORM 990 WILL BE PASSED ALONG TO BOARD MEMBERS 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. ANY DECLARATIONS OF CONFLICT OF INTEREST ARE 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 15 THE PRESIDENT IS COMPENSATED BY AVERA HEALTH SYSTEM. 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 FOR COMPENSATION 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 CAO AND CMO ARE COMPENSATED BY AVERA HEALTH PLANS. COMPENSATION IS DETERMINED BY AVERA HEALTH PLANS HUMAN RESOURCES BASED ON A MARKET ANALYSIS. THE COMPENSATION COMMITTEE APPROVES THE COMPENSATION OF THE CAO AND CMO. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION'S ARTICLES OF INCORPORATION ARE MADE AVAILABLE THROUGH THE SECRETARY OF STATE'S WEBSITE. (HTTPS://SOS.SD.GOV) STATUTORY FINANCIAL STATEMENTS ARE MADE AVAILABLE TO THE PUBLIC UPON REQUEST BY CONTACTING THE SOUTH DAKOTA DIVISION OF INSURANCE. THE CONFLICT OF INTEREST POLICY IS MADE AVAILABLE UPON REQUEST. FORM 990, PART VI, LINE 4 PRIOR TO OCTOBER 1, 2015, THE ORGANIZATION WAS TAXABLE AS A CORPORATION. THE ORGANIZATION FILED FORM 1024, APPLICATION FOR RECOGNITION OF EXEMPTION UNDER SECTION 501(A) WITH THE IRS AND WAS GRANTED RECOGNITION AS A TAX EXEMPT ENTITY UNDER IRC 501(C)(4) EFFECTIVE OCTOBER 1, 2015. FORM 990, PART XI, LINE 9: ACCUMULATED SURPLUS PRIOR TO TAX-EXEMPT STATUS 35,267,410. AVERA HEALTH 3900 W AVERA DRIVE SUITE 300 SIOUX FALLS SD 57108 460422673 PROMOTION OF HEALTH SD 501(C)(3) LINE 9 N/A 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 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 GETTYSBURG SD 57442 460234354 HEALTHCARE SERVICES SD 501(C)(3) LINE 3 AVERA ST MARY'S 0 AVERA AT HOME 5116 S SOLBERG AVE 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 3 AVERA HEALTH 0 AVERA MARSHALL 300 S BRUCE STREET MARSHALL MN 56258 410919153 HEALTHCARE SERVICES MN 501(C)(3) LINE 3 AVERA HEALTH 0 AVERA MARSHALL FOUNDATION 300 S BRUCE STREET MARSHALL MN 56258 411784801 FUNDRAISING MN 501(C)(3) LINE 7 AVERA MARSHALL 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 AVERA HOME MEDICAL EQUIPMENT OF MARSHALL LLC 1104 EAST COLLEGE DRIVE MARSHALL MN 56258 205271924 MEDICAL SERVICES - HOME MEDICAL EQUIPMENT SD N/A Q&M PROPERTIES LLC 525 NORTH FOSTER MITCHELL SD 57301 731652049 MEDICAL CLINIC BUILDING SD N/A SURGICAL ASSOCIATES ENDOSCOPY CLINIC LLC 310 S PENN 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 HEALTHCARE SERVICES 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 MEDICAL EQUIPMENT 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 0 0 1 0 0 0 0 0 0 0 0 0 1 0 1 1 1 0 0