AVERA MARSHALL: Form 990, tax year 2015

View the entire original 990 at ProPublica ↗

Organization: AVERA MARSHALL (EIN 41-0919153)
Tax period: 2015-07-01 to 2016-06-30
Filed: 2017-05-15
IRS object ID: 201701359349304160
Schema version: 2015v3.0
Source: Download XML · Original 990 at ProPublica

Every field in the e-filed return. Faint text is the IRS element name, for citing.

Return header
Form 990
Schedule A
Schedule B
Schedule C
Schedule D
Schedule H
Schedule I
Schedule J
Schedule L
Schedule O
Schedule R

Return header ReturnHeader

Field	Value	IRS element (for citing)
Return	2017-05-15T10:46:43-05:00	ReturnTs
Tax Period End	2016-06-30	TaxPeriodEndDt

Preparer Firm PreparerFirmGrp

Field	Value	IRS element (for citing)
Preparer Firm EIN	450250958	PreparerFirmEIN

Preparer Firm Name PreparerFirmName

Field	Value	IRS element (for citing)
Business Name Line1	Eide Bailly LLP	BusinessNameLine1Txt

Preparer US Address PreparerUSAddress

Field	Value	IRS element (for citing)
Address Line1	800 Nicollet Mall Ste 1300	AddressLine1Txt
City	Minneapolis	CityNm
State Abbreviation	MN	StateAbbreviationCd
ZIP	554027033	ZIPCd

Field	Value	IRS element (for citing)
Return Type	990	ReturnTypeCd
Tax Period Begin	2015-07-01	TaxPeriodBeginDt

Filer Filer

Field	Value	IRS element (for citing)
EIN	410919153	EIN

Business Name BusinessName

Field	Value	IRS element (for citing)
Business Name Line1	Avera Marshall	BusinessNameLine1Txt

Field	Value	IRS element (for citing)
Business Name Control	AVER	BusinessNameControlTxt
Phone	5075329661	PhoneNum

US Address USAddress

Field	Value	IRS element (for citing)
Address Line1	300 S Bruce Street	AddressLine1Txt
City	Marshall	CityNm
State Abbreviation	MN	StateAbbreviationCd
ZIP	562581934	ZIPCd

Business Officer BusinessOfficerGrp

Field	Value	IRS element (for citing)
Person	Mary Maertens	PersonNm
Person Title	President and CEO	PersonTitleTxt
Phone	5075329661	PhoneNum
Signature	2017-05-12	SignatureDt
Discuss With Paid Preparer	Yes (1)	DiscussWithPaidPreparerInd

Preparer Person PreparerPersonGrp

Field	Value	IRS element (for citing)
Preparer Person	Kim Hunwardsen CPA	PreparerPersonNm
PTIN	P00484560	PTIN
Phone	6122536500	PhoneNum
Preparation	2017-05-12	PreparationDt

Field	Value	IRS element (for citing)
Tax	2015	TaxYr
Build TS	2021-01-29 14:40:06Z	BuildTS

Form 990 IRS990

Doing Business As Name DoingBusinessAsName

Field	Value	IRS element (for citing)
Business Name Line1	Avera Marshall Regional Medical Center	BusinessNameLine1Txt

Field	Value	IRS element (for citing)
Principal Officer	Mary Maertens	PrincipalOfficerNm

US Address USAddress

Field	Value	IRS element (for citing)
Address Line1	300 S Bruce Street	AddressLine1Txt
City	Marshall	CityNm
State Abbreviation	MN	StateAbbreviationCd
ZIP	562581934	ZIPCd

Field	Value	IRS element (for citing)
Gross Receipts	$80,319,781	GrossReceiptsAmt
Group Return For Affiliates	0	GroupReturnForAffiliatesInd
Organization501c3	Yes (X)	Organization501c3Ind
Website Address	www.avera.org	WebsiteAddressTxt
Type Of Organization Corp	Yes (X)	TypeOfOrganizationCorpInd
Formation	1944	FormationYr
Legal Domicile State	MN	LegalDomicileStateCd
Activity Or Mission	Promotion of health	ActivityOrMissionDesc
Voting Members Governing Body	16	VotingMembersGoverningBodyCnt
Voting Members Independent	12	VotingMembersIndependentCnt
Total Employee	631	TotalEmployeeCnt
Total Volunteers	154	TotalVolunteersCnt
Total Gross UBI	$80,234	TotalGrossUBIAmt
Net Unrelated Bus Txbl Incm	$50,789	NetUnrelatedBusTxblIncmAmt
PY Contributions Grants	$6,236,684	PYContributionsGrantsAmt
CY Contributions Grants	$1,463,697	CYContributionsGrantsAmt
PY Program Service Revenue	$71,576,865	PYProgramServiceRevenueAmt
CY Program Service Revenue	$78,154,416	CYProgramServiceRevenueAmt
PY Investment Income	$774,848	PYInvestmentIncomeAmt
CY Investment Income	$546,608	CYInvestmentIncomeAmt
PY Other Revenue	-$62,884	PYOtherRevenueAmt
CY Other Revenue	$96,426	CYOtherRevenueAmt
PY Total Revenue	$78,525,513	PYTotalRevenueAmt
CY Total Revenue	$80,261,147	CYTotalRevenueAmt
PY Grants And Similar Paid	$33,185	PYGrantsAndSimilarPaidAmt
CY Grants And Similar Paid	$1,037,971	CYGrantsAndSimilarPaidAmt
PY Benefits Paid To Members	$0	PYBenefitsPaidToMembersAmt
CY Benefits Paid To Members	$0	CYBenefitsPaidToMembersAmt
PY Salaries Comp Emp Bnft Paid	$36,391,805	PYSalariesCompEmpBnftPaidAmt
CY Salaries Comp Emp Bnft Paid	$40,082,385	CYSalariesCompEmpBnftPaidAmt
PY Total Prof Fndrsng Expns	$0	PYTotalProfFndrsngExpnsAmt
CY Total Prof Fndrsng Expns	$0	CYTotalProfFndrsngExpnsAmt
CY Total Fundraising Expense	$164,607	CYTotalFundraisingExpenseAmt
PY Other Expenses	$33,717,021	PYOtherExpensesAmt
CY Other Expenses	$36,738,386	CYOtherExpensesAmt
PY Total Expenses	$70,142,011	PYTotalExpensesAmt
CY Total Expenses	$77,858,742	CYTotalExpensesAmt
PY Revenues Less Expenses	$8,383,502	PYRevenuesLessExpensesAmt
CY Revenues Less Expenses	$2,402,405	CYRevenuesLessExpensesAmt
Total Assets BOY	$81,356,490	TotalAssetsBOYAmt
Total Assets EOY	$87,053,246	TotalAssetsEOYAmt
Total Liabilities BOY	$22,819,848	TotalLiabilitiesBOYAmt
Total Liabilities EOY	$23,727,761	TotalLiabilitiesEOYAmt
Net Assets Or Fund Balances BOY	$58,536,642	NetAssetsOrFundBalancesBOYAmt
Net Assets Or Fund Balances EOY	$63,325,485	NetAssetsOrFundBalancesEOYAmt
Info In Schedule O Part III	Yes (X)	InfoInScheduleOPartIIIInd
Mission	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.	MissionDesc
Significant New Program Srvc	Yes (1)	SignificantNewProgramSrvcInd
Significant Change	0	SignificantChangeInd
Expense	$40,916,413	ExpenseAmt
Grant	$1,037,971	GrantAmt
Revenue	$53,407,861	RevenueAmt
Desc	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.	Desc

Prog Srvc Accom Acty2 ProgSrvcAccomActy2Grp

Field	Value	IRS element (for citing)
Expense	$5,924,530	ExpenseAmt
Revenue	$6,029,566	RevenueAmt
Desc	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.	Desc

Prog Srvc Accom Acty3 ProgSrvcAccomActy3Grp

Field	Value	IRS element (for citing)
Expense	$19,939,382	ExpenseAmt
Revenue	$18,660,758	RevenueAmt
Desc	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	Desc

Field	Value	IRS element (for citing)
Total Program Service Expenses	$66,780,325	TotalProgramServiceExpensesAmt
Described In Section501c3	Yes (1)	DescribedInSection501c3Ind
Schedule B Required	Yes (1)	ScheduleBRequiredInd
Political Campaign Acty	0	PoliticalCampaignActyInd
Lobbying Activities	Yes (1)	LobbyingActivitiesInd
Subject To Proxy Tax	0	SubjectToProxyTaxInd
Donor Advised Fund	0	DonorAdvisedFundInd
Conservation Easements	0	ConservationEasementsInd
Collections Of Art	0	CollectionsOfArtInd
Credit Counseling	Yes (1)	CreditCounselingInd
Temp Or Permanent Endowments	0	TempOrPermanentEndowmentsInd
Report Land Building Equipment	Yes (1)	ReportLandBuildingEquipmentInd
Report Investments Other Sec	Yes (1)	ReportInvestmentsOtherSecInd
Report Program Related Invst	0	ReportProgramRelatedInvstInd
Report Other Assets	0	ReportOtherAssetsInd
Report Other Liabilities	Yes (1)	ReportOtherLiabilitiesInd
Include FIN48 Footnote	Yes (1)	IncludeFIN48FootnoteInd
Independent Audit Fincl Stmt	0	IndependentAuditFinclStmtInd
Consolidated Audit Fincl Stmt	Yes (1)	ConsolidatedAuditFinclStmtInd
School Operating	0	SchoolOperatingInd
Foreign Office	0	ForeignOfficeInd
Foreign Activities	0	ForeignActivitiesInd
More Than5000 K To Org	0	MoreThan5000KToOrgInd
More Than5000 K To Individuals	0	MoreThan5000KToIndividualsInd
Professional Fundraising	0	ProfessionalFundraisingInd
Fundraising Activities	0	FundraisingActivitiesInd
Gaming Activities	0	GamingActivitiesInd
Operate Hospital	Yes (1)	OperateHospitalInd
Audited Financial Stmt Att	Yes (1)	AuditedFinancialStmtAttInd
Grants To Organizations	Yes (1)	GrantsToOrganizationsInd
Grants To Individuals	Yes (1)	GrantsToIndividualsInd
Schedule J Required	Yes (1)	ScheduleJRequiredInd
Tax Exempt Bonds	0	TaxExemptBondsInd
Engaged In Excess Benefit Trans	0	EngagedInExcessBenefitTransInd
PY Excess Benefit Trans	0	PYExcessBenefitTransInd
Loan Outstanding	Yes (1)	LoanOutstandingInd
Grant To Related Person	0	GrantToRelatedPersonInd
Business Rln With Org Mem	0	BusinessRlnWithOrgMemInd
Business Rln With Fam Mem	Yes (1)	BusinessRlnWithFamMemInd
Business Rln With Officer Ent	0	BusinessRlnWithOfficerEntInd
Deductible Non Cash Contri	0	DeductibleNonCashContriInd
Deductible Art Contribution	0	DeductibleArtContributionInd
Terminate Operations	0	TerminateOperationsInd
Partial Liquidation	0	PartialLiquidationInd
Disregarded Entity	0	DisregardedEntityInd
Related Entity	Yes (1)	RelatedEntityInd
Related Organization Ctrl Ent	Yes (1)	RelatedOrganizationCtrlEntInd
Transaction With Control Ent	Yes (1)	TransactionWithControlEntInd
Trnsfr Exmpt Non Chrtbl Rltd Org	0	TrnsfrExmptNonChrtblRltdOrgInd
Activities Conducted Prtshp	0	ActivitiesConductedPrtshpInd
Schedule O Required	Yes (1)	ScheduleORequiredInd
IRP Document	93	IRPDocumentCnt
IRP Document W2 G	0	IRPDocumentW2GCnt
Backup Wthld Compliance	Yes (1)	BackupWthldComplianceInd
Employee	631	EmployeeCnt
Employment Tax Returns Filed	Yes (1)	EmploymentTaxReturnsFiledInd
Unrelated Bus Incm Over Limit	Yes (1)	UnrelatedBusIncmOverLimitInd
Form990 T Filed	Yes (1)	Form990TFiledInd
Foreign Financial Account	0	ForeignFinancialAccountInd
Prohibited Tax Shelter Trans	0	ProhibitedTaxShelterTransInd
Taxable Party Notification	0	TaxablePartyNotificationInd
Nondeductible Contributions	0	NondeductibleContributionsInd
Quid Pro Quo Contributions	0	QuidProQuoContributionsInd
Form8282 Property Disposed Of	0	Form8282PropertyDisposedOfInd
Rcv Fnds To Pay Prsnl Bnft Cntrct	0	RcvFndsToPayPrsnlBnftCntrctInd
Pay Premiums Prsnl Bnft Cntrct	0	PayPremiumsPrsnlBnftCntrctInd
Indoor Tanning Services	0	IndoorTanningServicesInd
Info In Schedule O Part VI	Yes (X)	InfoInScheduleOPartVIInd
Governing Body Voting Members	16	GoverningBodyVotingMembersCnt
Independent Voting Member	12	IndependentVotingMemberCnt
Family Or Business Rln	Yes (1)	FamilyOrBusinessRlnInd
Delegation Of Mgmt Duties	0	DelegationOfMgmtDutiesInd
Change To Org Documents	0	ChangeToOrgDocumentsInd
Material Diversion Or Misuse	0	MaterialDiversionOrMisuseInd
Members Or Stockholders	Yes (1)	MembersOrStockholdersInd
Election Of Board Members	Yes (1)	ElectionOfBoardMembersInd
Decisions Subject To Approva	Yes (1)	DecisionsSubjectToApprovaInd
Minutes Of Governing Body	Yes (1)	MinutesOfGoverningBodyInd
Minutes Of Committees	Yes (1)	MinutesOfCommitteesInd
Officer Mailing Address	0	OfficerMailingAddressInd
Local Chapters	0	LocalChaptersInd
Form990 Provided To Gvrn Body	Yes (1)	Form990ProvidedToGvrnBodyInd
Conflict Of Interest Policy	Yes (1)	ConflictOfInterestPolicyInd
Annual Disclosure Covered Prsn	Yes (1)	AnnualDisclosureCoveredPrsnInd
Regular Monitoring Enfrc	Yes (1)	RegularMonitoringEnfrcInd
Whistleblower Policy	Yes (1)	WhistleblowerPolicyInd
Document Retention Policy	Yes (1)	DocumentRetentionPolicyInd
Compensation Process CEO	0	CompensationProcessCEOInd
Compensation Process Other	Yes (1)	CompensationProcessOtherInd
Investment In Joint Venture	Yes (1)	InvestmentInJointVentureInd
Written Policy Or Procedure	0	WrittenPolicyOrProcedureInd
States Where Copy Of Return Is Fld	MN	StatesWhereCopyOfReturnIsFldCd
Upon Request	Yes (X)	UponRequestInd

Books In Care Of Detail BooksInCareOfDetail

Business Name BusinessName

Field	Value	IRS element (for citing)
Business Name Line1	Sharon Williams	BusinessNameLine1Txt

Field	Value	IRS element (for citing)
Phone	5075379150	PhoneNum

US Address USAddress

Field	Value	IRS element (for citing)
Address Line1	300 S Bruce St	AddressLine1Txt
City	Marshall	CityNm
State Abbreviation	MN	StateAbbreviationCd
ZIP	562581934	ZIPCd

Form990 Part VII Section A Form990PartVIISectionAGrp (22 entries)

TitleTitleTxt	Average Hours Per WeekAverageHoursPerWeekRt	Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt	Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd	OfficerOfficerInd	Reportable Comp From OrgReportableCompFromOrgAmt	Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt	Other CompensationOtherCompensationAmt	Highest Compensated EmployeeHighestCompensatedEmployeeInd
Roger Pabst OD
Chair/Provider	15.30	1.30	Yes (X)	Yes (X)	$59,087	$0	$8,668
Joyce Strootman
Vice Chair	1.30	1.30	Yes (X)	Yes (X)	$0	$0	$0
Todd Bock
Director	1.30	1.30	Yes (X)		$0	$0	$0
James H Fuhrmann
Director	1.30	1.30	Yes (X)		$0	$0	$0
Donna Hartfiel MD
Director/Physician	41.30	1.30	Yes (X)		$0	$139,612	$6,003
Sr Carmella Luke
Director	1.30	1.30	Yes (X)		$0	$0	$0
Doug Olsen
Director	1.30	1.30	Yes (X)		$0	$0	$0
Randy Gaffney
Director	1.50	1.30	Yes (X)		$0	$0	$0
Sr Mary J Reichelt
Director	1.30	4.50	Yes (X)		$0	$0	$0
Michael K Rich
Director	1.30	1.30	Yes (X)		$0	$0	$0
Sr Roxanne Seifert
Director	1.30	40.00	Yes (X)		$0	$0	$0
Randy Serreyn
Director	1.50	1.30	Yes (X)		$0	$0	$0
Quentin Fixen
Director	1.30	1.30	Yes (X)		$0	$0	$0
Laurie Johansen
DIrector	1.30	1.30	Yes (X)		$0	$0	$0
George Jorgensen
Director	1.30	1.30	Yes (X)		$0	$0	$0
Mary B Maertens
President & CEO	40.00	2.50	Yes (X)	Yes (X)	$0	$356,945	$43,314
Sharon Williams
Sec/Treas & VP Finance	40.00	0.10		Yes (X)	$167,817	$0	$26,789
Curtis Louwagie MD
Physician	40.00	0.00			$658,233	$0	$26,732	Yes (X)
Vikram Chatrath MD
Physician	40.00	0.00			$799,867	$0	$28,532	Yes (X)
Traci Kruse MD
Physician	40.00	0.00			$427,497	$0	$5,300	Yes (X)
Ajay Shalwala MD
Physician	40.00	0.00			$493,186	$0	$11,390	Yes (X)
Syed Hasan MD
Physician	40.00	0.00			$571,502	$0	$13,284	Yes (X)

Field	Value	IRS element (for citing)
Total Reportable Comp From Org	$3,177,189	TotalReportableCompFromOrgAmt
Tot Reportable Comp Rltd Org	$496,557	TotReportableCompRltdOrgAmt
Total Other Compensation	$170,012	TotalOtherCompensationAmt
Indiv Rcvd Greater Than100 K	49	IndivRcvdGreaterThan100KCnt
Former Ofcr Employees Listed	0	FormerOfcrEmployeesListedInd
Total Comp Greater Than150 K	Yes (1)	TotalCompGreaterThan150KInd
Compensation From Other Srcs	0	CompensationFromOtherSrcsInd

Contractor Compensation ContractorCompensationGrp (5 entries)

Address Line1ContractorAddress/USAddress/AddressLine1Txt	CityContractorAddress/USAddress/CityNm	State AbbreviationContractorAddress/USAddress/StateAbbreviationCd	ZIPContractorAddress/USAddress/ZIPCd	ServicesServicesDesc	CompensationCompensationAmt
Avera Health
3900 W Avera Dr Ste 301	Sioux Falls	SD	57105	Shared services	$7,095,846
Avera McKennan
1001 E 21st ST Ste 401	Sioux Falls	SD	57105	Physicians and Anciliary	$2,427,352
Big Stone Therapies Inc
209 Waginston Ave	Ortonville	MN	56278	Therapy Services	$2,143,439
Weatherby Locums Inc
PO Box 977633	Dallas	TX	75397	Locum physicians	$817,102
Stinson Leonard Street LLP
PO Box 843052	Kansas City	MO	64184	Legal services	$637,751

Field	Value	IRS element (for citing)
Cntrct Rcvd Greater Than100 K	14	CntrctRcvdGreaterThan100KCnt
Related Organizations	$1,167,024	RelatedOrganizationsAmt
Government Grants	$254,206	GovernmentGrantsAmt
All Other Contributions	$42,467	AllOtherContributionsAmt
Total Contributions	$1,463,697	TotalContributionsAmt

Program Service Revenue ProgramServiceRevenueGrp (5 entries)

DescDesc	BusinessBusinessCd	Total Revenue ColumnTotalRevenueColumnAmt	Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt	Unrelated Business RevenueUnrelatedBusinessRevenueAmt
Net Patient Service Revenue	622110	$75,220,589	$75,220,589
Pharmacy Revenue	900099	$1,346,406	$1,346,406
Meaningful Use Revenue	900099	$438,714	$438,714
Gain on Auxiliary	900099	$272,096	$272,096
Equity Earnings of Affiliated Org	900099	$209,224	$182,382	$26,842

Total Oth Program Service Rev TotalOthProgramServiceRevGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$667,387	TotalRevenueColumnAmt
Related Or Exempt Func Income	$613,995	RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue	$53,392	UnrelatedBusinessRevenueAmt

Field	Value	IRS element (for citing)
Total Program Service Revenue	$78,154,416	TotalProgramServiceRevenueAmt

Investment Income InvestmentIncomeGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$552,267	TotalRevenueColumnAmt
Exclusion	$552,267	ExclusionAmt

Gross Rents GrossRentsGrp

Field	Value	IRS element (for citing)
Real	$125,398	RealAmt

Less Rental Expenses LessRentalExpensesGrp

Field	Value	IRS element (for citing)
Real	$52,975	RealAmt

Rental Income Or Loss RentalIncomeOrLossGrp

Field	Value	IRS element (for citing)
Real	$72,423	RealAmt

Net Rental Income Or Loss NetRentalIncomeOrLossGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$72,423	TotalRevenueColumnAmt
Exclusion	$72,423	ExclusionAmt

Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp

Field	Value	IRS element (for citing)
Other	$5,659	OtherAmt

Gain Or Loss GainOrLossGrp

Field	Value	IRS element (for citing)
Other	-$5,659	OtherAmt

Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp

Field	Value	IRS element (for citing)
Total Revenue Column	-$5,659	TotalRevenueColumnAmt
Exclusion	-$5,659	ExclusionAmt

Other Revenue Misc OtherRevenueMiscGrp

Field	Value	IRS element (for citing)
Desc	Operating interest	Desc
Business	900099	BusinessCd
Total Revenue Column	$24,003	TotalRevenueColumnAmt
Related Or Exempt Func Income	$24,003	RelatedOrExemptFuncIncomeAmt

Field	Value	IRS element (for citing)
Other Revenue Total	$24,003	OtherRevenueTotalAmt

Total Revenue TotalRevenueGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$80,261,147	TotalRevenueColumnAmt
Related Or Exempt Func Income	$78,098,185	RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue	$80,234	UnrelatedBusinessRevenueAmt
Exclusion	$619,031	ExclusionAmt

Field	Value	IRS element (for citing)
Info In Schedule O Part IX	Yes (X)	InfoInScheduleOPartIXInd

Grants To Domestic Orgs GrantsToDomesticOrgsGrp

Field	Value	IRS element (for citing)
Total	$1,000,000	TotalAmt
Program Services	$1,000,000	ProgramServicesAmt

Grants To Domestic Individuals GrantsToDomesticIndividualsGrp

Field	Value	IRS element (for citing)
Total	$37,971	TotalAmt
Program Services	$37,971	ProgramServicesAmt

Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp

Field	Value	IRS element (for citing)
Total	$236,373	TotalAmt
Program Services	$38,077	ProgramServicesAmt
Management And General	$198,296	ManagementAndGeneralAmt

Comp Disqual Persons CompDisqualPersonsGrp

Field	Value	IRS element (for citing)
Total	$115,883	TotalAmt
Program Services	$115,883	ProgramServicesAmt

Other Salaries And Wages OtherSalariesAndWagesGrp

Field	Value	IRS element (for citing)
Total	$31,776,387	TotalAmt
Program Services	$29,964,298	ProgramServicesAmt
Management And General	$1,707,201	ManagementAndGeneralAmt
Fundraising	$104,888	FundraisingAmt

Pension Plan Contributions PensionPlanContributionsGrp

Field	Value	IRS element (for citing)
Total	$1,729,603	TotalAmt
Program Services	$1,582,652	ProgramServicesAmt
Management And General	$141,100	ManagementAndGeneralAmt
Fundraising	$5,851	FundraisingAmt

Other Employee Benefits OtherEmployeeBenefitsGrp

Field	Value	IRS element (for citing)
Total	$4,397,311	TotalAmt
Program Services	$4,006,058	ProgramServicesAmt
Management And General	$373,945	ManagementAndGeneralAmt
Fundraising	$17,308	FundraisingAmt

Payroll Taxes PayrollTaxesGrp

Field	Value	IRS element (for citing)
Total	$1,826,828	TotalAmt
Program Services	$1,669,383	ProgramServicesAmt
Management And General	$150,154	ManagementAndGeneralAmt
Fundraising	$7,291	FundraisingAmt

Fees For Services Legal FeesForServicesLegalGrp

Field	Value	IRS element (for citing)
Total	$339,182	TotalAmt
Management And General	$339,147	ManagementAndGeneralAmt
Fundraising	$35	FundraisingAmt

Fees For Services Accounting FeesForServicesAccountingGrp

Field	Value	IRS element (for citing)
Total	$17,289	TotalAmt
Program Services	$10,204	ProgramServicesAmt
Management And General	$7,085	ManagementAndGeneralAmt

Fees For Services Lobbying FeesForServicesLobbyingGrp

Field	Value	IRS element (for citing)
Total	$3,193	TotalAmt
Program Services	$3,193	ProgramServicesAmt

Fees For Services Other FeesForServicesOtherGrp

Field	Value	IRS element (for citing)
Total	$10,019,433	TotalAmt
Program Services	$6,159,557	ProgramServicesAmt
Management And General	$3,859,876	ManagementAndGeneralAmt

Advertising AdvertisingGrp

Field	Value	IRS element (for citing)
Total	$1,633	TotalAmt
Management And General	$1,633	ManagementAndGeneralAmt

Office Expenses OfficeExpensesGrp

Field	Value	IRS element (for citing)
Total	$981,932	TotalAmt
Program Services	$871,863	ProgramServicesAmt
Management And General	$109,420	ManagementAndGeneralAmt
Fundraising	$649	FundraisingAmt

Information Technology InformationTechnologyGrp

Field	Value	IRS element (for citing)
Total	$2,023,868	TotalAmt
Program Services	$32,554	ProgramServicesAmt
Management And General	$1,991,314	ManagementAndGeneralAmt

Occupancy OccupancyGrp

Field	Value	IRS element (for citing)
Total	$1,281,584	TotalAmt
Program Services	$1,109,153	ProgramServicesAmt
Management And General	$172,431	ManagementAndGeneralAmt

Travel TravelGrp

Field	Value	IRS element (for citing)
Total	$494,355	TotalAmt
Program Services	$456,816	ProgramServicesAmt
Management And General	$34,864	ManagementAndGeneralAmt
Fundraising	$2,675	FundraisingAmt

Conferences Meetings ConferencesMeetingsGrp

Field	Value	IRS element (for citing)
Total	$23,040	TotalAmt
Program Services	$8,339	ProgramServicesAmt
Management And General	$14,701	ManagementAndGeneralAmt

Interest InterestGrp

Field	Value	IRS element (for citing)
Total	$556,542	TotalAmt
Program Services	$556,542	ProgramServicesAmt

Depreciation Depletion DepreciationDepletionGrp

Field	Value	IRS element (for citing)
Total	$3,953,448	TotalAmt
Program Services	$3,733,682	ProgramServicesAmt
Management And General	$215,658	ManagementAndGeneralAmt
Fundraising	$4,108	FundraisingAmt

Insurance InsuranceGrp

Field	Value	IRS element (for citing)
Total	$365,933	TotalAmt
Program Services	$187,243	ProgramServicesAmt
Management And General	$178,690	ManagementAndGeneralAmt

Other Expenses OtherExpensesGrp (4 entries)

DescDesc	TotalTotalAmt	Program ServicesProgramServicesAmt	Management And GeneralManagementAndGeneralAmt
Medical Supplies	$10,667,394	$10,666,842	$552
Fees, Taxes and Surchar	$2,085,412	$853,937	$1,231,475
Bad Debt Expense	$1,885,523	$1,885,523
Provision for income ta	$33,610	$33,610

All Other Expenses AllOtherExpensesGrp

Field	Value	IRS element (for citing)
Total	$2,005,015	TotalAmt
Program Services	$1,796,945	ProgramServicesAmt
Management And General	$186,268	ManagementAndGeneralAmt
Fundraising	$21,802	FundraisingAmt

Total Functional Expenses TotalFunctionalExpensesGrp

Field	Value	IRS element (for citing)
Total	$77,858,742	TotalAmt
Program Services	$66,780,325	ProgramServicesAmt
Management And General	$10,913,810	ManagementAndGeneralAmt
Fundraising	$164,607	FundraisingAmt

Savings And Temp Cash Invst SavingsAndTempCashInvstGrp

Field	Value	IRS element (for citing)
BOY	$3,995,270	BOYAmt
EOY	$6,209,015	EOYAmt

Pledges And Grants Receivable PledgesAndGrantsReceivableGrp

Field	Value	IRS element (for citing)
EOY	$463,374	EOYAmt

Accounts Receivable AccountsReceivableGrp

Field	Value	IRS element (for citing)
BOY	$9,670,159	BOYAmt
EOY	$12,412,487	EOYAmt

Receivables From Officers Etc ReceivablesFromOfficersEtcGrp

Field	Value	IRS element (for citing)
BOY	$130,000	BOYAmt
EOY	$204,583	EOYAmt

Inventories For Sale Or Use InventoriesForSaleOrUseGrp

Field	Value	IRS element (for citing)
BOY	$1,948,868	BOYAmt
EOY	$1,960,415	EOYAmt

Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp

Field	Value	IRS element (for citing)
BOY	$1,384,481	BOYAmt
EOY	$1,351,896	EOYAmt

Field	Value	IRS element (for citing)
Land Bldg Equip Cost Or Other Bss	$84,952,820	LandBldgEquipCostOrOtherBssAmt
Land Bldg Equip Accum Deprec	$51,879,194	LandBldgEquipAccumDeprecAmt

Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp

Field	Value	IRS element (for citing)
BOY	$35,665,953	BOYAmt
EOY	$33,073,626	EOYAmt

Investments Other Securities InvestmentsOtherSecuritiesGrp

Field	Value	IRS element (for citing)
BOY	$27,071,202	BOYAmt
EOY	$30,570,102	EOYAmt

Investments Program Related InvestmentsProgramRelatedGrp

Field	Value	IRS element (for citing)
BOY	$1,179,542	BOYAmt
EOY	$393,632	EOYAmt

Intangible Assets IntangibleAssetsGrp

Field	Value	IRS element (for citing)
BOY	$311,015	BOYAmt
EOY	$414,116	EOYAmt

Total Assets TotalAssetsGrp

Field	Value	IRS element (for citing)
BOY	$81,356,490	BOYAmt
EOY	$87,053,246	EOYAmt

Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp

Field	Value	IRS element (for citing)
BOY	$5,196,284	BOYAmt
EOY	$5,655,726	EOYAmt

Tax Exempt Bond Liabilities TaxExemptBondLiabilitiesGrp

Field	Value	IRS element (for citing)
BOY	$16,519,555	BOYAmt
EOY	$16,257,452	EOYAmt

Escrow Account Liability EscrowAccountLiabilityGrp

Field	Value	IRS element (for citing)
BOY	$6,466	BOYAmt
EOY	$5,730	EOYAmt

Other Liabilities OtherLiabilitiesGrp

Field	Value	IRS element (for citing)
BOY	$1,097,543	BOYAmt
EOY	$1,808,853	EOYAmt

Total Liabilities TotalLiabilitiesGrp

Field	Value	IRS element (for citing)
BOY	$22,819,848	BOYAmt
EOY	$23,727,761	EOYAmt

Field	Value	IRS element (for citing)
Organization Follows SFAS117	Yes (X)	OrganizationFollowsSFAS117Ind

Unrestricted Net Assets UnrestrictedNetAssetsGrp

Field	Value	IRS element (for citing)
BOY	$58,536,642	BOYAmt
EOY	$61,015,359	EOYAmt

Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp

Field	Value	IRS element (for citing)
EOY	$1,868,099	EOYAmt

Permanently Rstr Net Assets PermanentlyRstrNetAssetsGrp

Field	Value	IRS element (for citing)
EOY	$442,027	EOYAmt

Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp

Field	Value	IRS element (for citing)
BOY	$58,536,642	BOYAmt
EOY	$63,325,485	EOYAmt

Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp

Field	Value	IRS element (for citing)
BOY	$81,356,490	BOYAmt
EOY	$87,053,246	EOYAmt

Field	Value	IRS element (for citing)
Info In Schedule O Part XI	Yes (X)	InfoInScheduleOPartXIInd
Reconcilation Revenue Expnss	$2,402,405	ReconcilationRevenueExpnssAmt
Net Unrlzd Gains Losses Invst	-$505,501	NetUnrlzdGainsLossesInvstAmt
Other Changes In Net Assets	$2,891,939	OtherChangesInNetAssetsAmt
Info In Schedule O Part XII	Yes (X)	InfoInScheduleOPartXIIInd
Method Of Accounting Accrual	Yes (X)	MethodOfAccountingAccrualInd
Accountant Compile Or Review	0	AccountantCompileOrReviewInd
FS Audited	Yes (1)	FSAuditedInd

FS Audited Basis FSAuditedBasisGrp

Field	Value	IRS element (for citing)
Consolidated Basis Fincl Stmt	Yes (X)	ConsolidatedBasisFinclStmtInd

Field	Value	IRS element (for citing)
Audit Committee	Yes (1)	AuditCommitteeInd
Federal Grant Audit Required	0	FederalGrantAuditRequiredInd

Schedule A IRS990ScheduleA

Field	Value	IRS element (for citing)
Hospital	Yes (X)	HospitalInd

Schedule B IRS990ScheduleB

Contributor Information ContributorInformationGrp

Field	Value	IRS element (for citing)
Contributor	RESTRICTED	ContributorNum

Contributor Business Name ContributorBusinessName

Field	Value	IRS element (for citing)
Business Name Line1	RESTRICTED	BusinessNameLine1

Contributor US Address ContributorUSAddress

Field	Value	IRS element (for citing)
Address Line1	RESTRICTED	AddressLine1
Address Line2	RESTRICTED	AddressLine2
City	RESTRICTED	City
State	RESTRICTED	State
ZIP Code	RESTRICTED	ZIPCode

Field	Value	IRS element (for citing)
Total Contributions	RESTRICTED	TotalContributionsAmt

Schedule C IRS990ScheduleC

Field	Value	IRS element (for citing)
Volunteers	0	VolunteersInd
Paid Staff Or Management	0	PaidStaffOrManagementInd
Media Advertisements	0	MediaAdvertisementsInd
Mailings Members	0	MailingsMembersInd
Publications Or Broadcast	0	PublicationsOrBroadcastInd
Grants Other Organizations	0	GrantsOtherOrganizationsInd
Direct Contact Legislators	0	DirectContactLegislatorsInd
Rallies Demonstrations	0	RalliesDemonstrationsInd
Other Activities	Yes (1)	OtherActivitiesInd
Other Activities	$3,193	OtherActivitiesAmt
Total Lobbying Expenditures	$3,193	TotalLobbyingExpendituresAmt
Not Described Section501c3	0	NotDescribedSection501c3Ind

Supplemental Information Detail SupplementalInformationDetail

Field	Value	IRS element (for citing)
Form And Line Reference	Part II-B, Line 1:	FormAndLineReferenceDesc
Explanation	Avera Marshall paid dues to organizations which have a portion of the dues attributed to lobbying activities.	ExplanationTxt

Schedule D IRS990ScheduleD

Field	Value	IRS element (for citing)
Agent Trustee Etc	0	AgentTrusteeEtcInd
Incl Escrow Custodial Acct Liab	Yes (1)	InclEscrowCustodialAcctLiabInd
Explanation Provided	Yes (X)	ExplanationProvidedInd

Land LandGrp

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	$536,512	OtherCostOrOtherBasisAmt
Book Value	$536,512	BookValueAmt

Buildings BuildingsGrp

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	$51,778,897	OtherCostOrOtherBasisAmt
Depreciation	$28,848,438	DepreciationAmt
Book Value	$22,930,459	BookValueAmt

Leasehold Improvements LeaseholdImprovementsGrp

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	$216,918	OtherCostOrOtherBasisAmt
Depreciation	$67,743	DepreciationAmt
Book Value	$149,175	BookValueAmt

Equipment EquipmentGrp

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	$30,107,087	OtherCostOrOtherBasisAmt
Depreciation	$21,859,331	DepreciationAmt
Book Value	$8,247,756	BookValueAmt

Other Land Buildings OtherLandBuildingsGrp

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	$2,313,406	OtherCostOrOtherBasisAmt
Depreciation	$1,103,682	DepreciationAmt
Book Value	$1,209,724	BookValueAmt

Field	Value	IRS element (for citing)
Total Book Value Land Buildings	$33,073,626	TotalBookValueLandBuildingsAmt

Other Securities OtherSecuritiesGrp (2 entries)

DescDesc	Book ValueBookValueAmt	Method ValuationMethodValuationCd
Investment in Affiliated Organizations	$3,791,211	F
Assets Limited to Use-Avera Pooled Investments	$26,778,891	F

Field	Value	IRS element (for citing)
Total Book Value Securities	$30,570,102	TotalBookValueSecuritiesAmt

Other Liabilities Org OtherLiabilitiesOrgGrp

Field	Value	IRS element (for citing)
Desc	Estimated Third-Party Payor Settlements	Desc
Amt	$1,808,853	Amt

Field	Value	IRS element (for citing)
Total Liability	$1,808,853	TotalLiabilityAmt
Footnote Text	Yes (X)	FootnoteTextInd

Supplemental Information Detail SupplementalInformationDetail (2 entries)

Form And Line ReferenceFormAndLineReferenceDesc

ExplanationExplanationTxt

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.

Schedule H IRS990ScheduleH

Field	Value	IRS element (for citing)
Financial Assistance Policy	Yes (1)	FinancialAssistancePolicyInd
Written Policy	Yes (1)	WrittenPolicyInd
All Hospitals Policy	Yes (X)	AllHospitalsPolicyInd
FPG Reference Free Care	Yes (1)	FPGReferenceFreeCareInd
Percent150	Yes (X)	Percent150Ind
FPG Reference Discounted Care	Yes (1)	FPGReferenceDiscountedCareInd
Percent400	Yes (X)	Percent400Ind
Free Care Medically Indigent	Yes (1)	FreeCareMedicallyIndigentInd
Financial Assistance Budget	Yes (1)	FinancialAssistanceBudgetInd
Expenses Exceed Budget	Yes (1)	ExpensesExceedBudgetInd
Unable To Provide Care	0	UnableToProvideCareInd
Annual Community Bnft Report	Yes (1)	AnnualCommunityBnftReportInd
Report Publically Available	Yes (1)	ReportPublicallyAvailableInd

Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$318,650	TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns	$318,650	NetCommunityBenefitExpnsAmt
Total Expense	0.00420	TotalExpensePct

Unreimbursed Medicaid UnreimbursedMedicaidGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$5,804,569	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$4,660,043	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$1,144,526	NetCommunityBenefitExpnsAmt
Total Expense	0.01510	TotalExpensePct

Total Financial Assistance Typ TotalFinancialAssistanceTyp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$6,123,219	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$4,660,043	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$1,463,176	NetCommunityBenefitExpnsAmt
Total Expense	0.01930	TotalExpensePct

Subsidized Health Services SubsidizedHealthServicesGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$6,512,384	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$2,600,987	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$3,911,397	NetCommunityBenefitExpnsAmt
Total Expense	0.05150	TotalExpensePct

Total Other Benefits TotalOtherBenefitsGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$6,512,384	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$2,600,987	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$3,911,397	NetCommunityBenefitExpnsAmt
Total Expense	0.05150	TotalExpensePct

Total Community Benefits TotalCommunityBenefitsGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$12,635,603	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$7,261,030	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$5,374,573	NetCommunityBenefitExpnsAmt
Total Expense	0.07080	TotalExpensePct

Field	Value	IRS element (for citing)
Bad Debt Expense Reported	Yes (1)	BadDebtExpenseReportedInd
Bad Debt Expense	$1,885,523	BadDebtExpenseAmt
Bad Debt Expense Attributable	$0	BadDebtExpenseAttributableAmt
Reimbursed By Medicare	$19,158,124	ReimbursedByMedicareAmt
Cost Of Care Reimbursed By Medcr	$19,273,466	CostOfCareReimbursedByMedcrAmt
Medicare Surplus Or Shortfall	-$115,342	MedicareSurplusOrShortfallAmt

Costing Methodology Used CostingMethodologyUsedGrp

Field	Value	IRS element (for citing)
Other	Yes (X)	OtherInd

Field	Value	IRS element (for citing)
Written Debt Collection Policy	Yes (1)	WrittenDebtCollectionPolicyInd
Financial Assistance Prvsn	Yes (1)	FinancialAssistancePrvsnInd
Hospital Facilities	1	HospitalFacilitiesCnt

Hospital Facilities HospitalFacilitiesGrp

Field	Value	IRS element (for citing)
Facility	1	FacilityNum

Business Name BusinessName

Field	Value	IRS element (for citing)
Business Name Line1	Avera Marshall Regional Medical Center	BusinessNameLine1Txt

US Address USAddress

Field	Value	IRS element (for citing)
Address Line1	300 S Bruce Street	AddressLine1Txt
City	Marshall	CityNm
State Abbreviation	MN	StateAbbreviationCd
ZIP	56258	ZIPCd

Field	Value	IRS element (for citing)
Website Address	www.averamarshall.org	WebsiteAddressTxt
State License	00343	StateLicenseNum
Licensed Hospital	Yes (X)	LicensedHospitalInd
General Medical And Surgical	Yes (X)	GeneralMedicalAndSurgicalInd
Critical Access Hospital	Yes (X)	CriticalAccessHospitalInd
Emergency Room24 Hrs	Yes (X)	EmergencyRoom24HrsInd
Other	8 Provider Based Clinics	OtherDesc

Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp

Hospital Facility Name HospitalFacilityName

Field	Value	IRS element (for citing)
Business Name Line1	Avera Marshall	BusinessNameLine1Txt

Field	Value	IRS element (for citing)
Facility	1	FacilityNum
First Licensed CY Or PY	0	FirstLicensedCYOrPYInd
Tax Exempt Hospital CY Or PY	0	TaxExemptHospitalCYOrPYInd
CHNA Conducted	Yes (1)	CHNAConductedInd
Community Definition	Yes (X)	CommunityDefinitionInd
Community Demographics	Yes (X)	CommunityDemographicsInd
Existing Resources	Yes (X)	ExistingResourcesInd
How Data Obtained	Yes (X)	HowDataObtainedInd
Community Health Needs	Yes (X)	CommunityHealthNeedsInd
Other Health Issues	Yes (X)	OtherHealthIssuesInd
Community Hlth Needs Id Process	Yes (X)	CommunityHlthNeedsIdProcessInd
Consulting Process	Yes (X)	ConsultingProcessInd
Information Gaps	Yes (X)	InformationGapsInd
CHNA Conducted	15	CHNAConductedYr
Take Into Account Others Input	Yes (1)	TakeIntoAccountOthersInputInd
CHNA Conducted With Other Fclts	0	CHNAConductedWithOtherFcltsInd
CHNA Conducted With Non Fclts	Yes (1)	CHNAConductedWithNonFcltsInd
CHNA Report Widely Available	Yes (1)	CHNAReportWidelyAvailableInd
Rpt Available On Own Website	Yes (X)	RptAvailableOnOwnWebsiteInd
Own Website URL	www.avera.org/marshall/	OwnWebsiteURLTxt
Other Website	Yes (X)	OtherWebsiteInd
Other Website URL	See Part V, Page 7	OtherWebsiteURLTxt
Paper Copy Public Inspection	Yes (X)	PaperCopyPublicInspectionInd
Implementation Strategy Adopt	Yes (1)	ImplementationStrategyAdoptInd
Implementation Strategy Adpt	15	ImplementationStrategyAdptYr
Strategy Posted Website	Yes (1)	StrategyPostedWebsiteInd
Strategy Website URL	See Part V, Page 7	StrategyWebsiteURLTxt
Strategy Attached	0	StrategyAttachedInd
Organization Incur Excise Tax	0	OrganizationIncurExciseTaxInd
Elig Criteria Explained	Yes (1)	EligCriteriaExplainedInd
FPG Family Incm Lmt Free Dscnt	Yes (X)	FPGFamilyIncmLmtFreeDscntInd
FPG Family Incm Lmt Free Care	150.000000000000	FPGFamilyIncmLmtFreeCarePct
FPG Family Incm Lmt Dscnt Care	400.000000000000	FPGFamilyIncmLmtDscntCarePct
Asset Level Criteria	Yes (X)	AssetLevelCriteriaInd
Medical Indigency Criteria	Yes (X)	MedicalIndigencyCriteriaInd
Insurance Status Criteria	Yes (X)	InsuranceStatusCriteriaInd
Other Criteria	Yes (X)	OtherCriteriaInd
Explained Basis	Yes (1)	ExplainedBasisInd
App Financial Asst Expln	Yes (1)	AppFinancialAsstExplnInd
Described Info	Yes (X)	DescribedInfoInd
Described Suprt Doc	Yes (X)	DescribedSuprtDocInd
Provided Hospital Contact	Yes (X)	ProvidedHospitalContactInd
Includes Publicity Measures	Yes (1)	IncludesPublicityMeasuresInd
FAP Available On Website	Yes (X)	FAPAvailableOnWebsiteInd
FAP Available On Website URL	http://www.avera.org/experience/ah/financial-assistance-charity-care/	FAPAvailableOnWebsiteURLTxt
FAP App Available On Website	Yes (X)	FAPAppAvailableOnWebsiteInd
FAP App Available On Website URL	http://www.avera.org/experience/ah/financial-assistance-charity-care/	FAPAppAvailableOnWebsiteURLTxt
FAP Summary On Website	Yes (X)	FAPSummaryOnWebsiteInd
FAP Summary On Website URL	http://www.avera.org/experience/ah/financial-assistance-charity-care/	FAPSummaryOnWebsiteURLTxt
FAP Avlbl On Request No Charge	Yes (X)	FAPAvlblOnRequestNoChargeInd
FAP App Avlbl On Request No Chrg	Yes (X)	FAPAppAvlblOnRequestNoChrgInd
FAP Sum Avlbl On Request No Chrg	Yes (X)	FAPSumAvlblOnRequestNoChrgInd
FAP Notice Displayed	Yes (X)	FAPNoticeDisplayedInd
Communtity Notified FAP	Yes (X)	CommuntityNotifiedFAPInd
Other Publicity	Yes (X)	OtherPublicityInd
FAP Actions On Nonpayment	Yes (1)	FAPActionsOnNonpaymentInd
Permit No Actions	Yes (X)	PermitNoActionsInd
Collection Activities	0	CollectionActivitiesInd
FAP Notified Upon Admission	Yes (X)	FAPNotifiedUponAdmissionInd
FAP Notified Before Discharge	Yes (X)	FAPNotifiedBeforeDischargeInd
FAP Notified All Patients	Yes (X)	FAPNotifiedAllPatientsInd
Documented Elig Determination	Yes (X)	DocumentedEligDeterminationInd
Other Actions Taken	Yes (X)	OtherActionsTakenInd
Nondis Emergency Care Policy	Yes (1)	NondisEmergencyCarePolicyInd
Other Method Used	Yes (X)	OtherMethodUsedInd
Amounts Generally Billed	0	AmountsGenerallyBilledInd
Gross Charges	Yes (1)	GrossChargesInd

Supplemental Information SupplementalInformationGrp (10 entries)

Form And Line ReferenceFormAndLineReferenceDesc	ExplanationExplanationTxt
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/

Field	Value	IRS element (for citing)
Facility	6	FacilityNum

Oth Hlth Care Fclts Not Hospital OthHlthCareFcltsNotHospitalGrp

Oth Hlth Care Fclts OthHlthCareFcltsGrp (6 entries)

Address Line1USAddress/AddressLine1Txt	CityUSAddress/CityNm	State AbbreviationUSAddress/StateAbbreviationCd	ZIPUSAddress/ZIPCd	FacilityFacilityTxt
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

Supplemental Information Detail SupplementalInformationDetail (15 entries)

Form And Line ReferenceFormAndLineReferenceDesc	ExplanationExplanationTxt
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.

Schedule I IRS990ScheduleI

Field	Value	IRS element (for citing)
Grant Records Maintained	Yes (1)	GrantRecordsMaintainedInd

Recipient Table RecipientTable

Recipient Business Name RecipientBusinessName

Field	Value	IRS element (for citing)
Business Name Line1	City of Marshall	BusinessNameLine1Txt

US Address USAddress

Field	Value	IRS element (for citing)
Address Line1	344 West Main Street	AddressLine1Txt
City	Marshall	CityNm
State Abbreviation	MN	StateAbbreviationCd
ZIP	56258	ZIPCd

Field	Value	IRS element (for citing)
Recipient EIN	416005351	RecipientEIN
IRC Section	City of Marshall	IRCSectionDesc
Cash Grant	$1,000,000	CashGrantAmt
Purpose Of Grant	Community benefit	PurposeOfGrantTxt

Field	Value	IRS element (for citing)
Total501c3 Org	1	Total501c3OrgCnt
Total Other Org	0	TotalOtherOrgCnt

Grants Other Asst To Indiv In US GrantsOtherAsstToIndivInUSGrp (3 entries)

Grant TypeGrantTypeTxt	RecipientRecipientCnt	Cash GrantCashGrantAmt
LTC Nursing Scholarships	9	$13,569
LTC Adult Day Care Scholarship	1	$402
Medical Student Scholarships	4	$24,000

Supplemental Information Detail SupplementalInformationDetail

Field	Value	IRS element (for citing)
Form And Line Reference	Part I, Line 2:	FormAndLineReferenceDesc
Explanation	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.	ExplanationTxt

Schedule J IRS990ScheduleJ

Field	Value	IRS element (for citing)
Severance Payment	0	SeverancePaymentInd
Supplemental Nonqual Rtr Plan	0	SupplementalNonqualRtrPlanInd
Equity Based Comp Arrngm	0	EquityBasedCompArrngmInd
Comp Based On Revenue Of Flng Org	0	CompBasedOnRevenueOfFlngOrgInd
Comp Bsd On Rev Related Orgs	0	CompBsdOnRevRelatedOrgsInd
Comp Bsd Net Earns Flng Org	0	CompBsdNetEarnsFlngOrgInd
Comp Bsd Net Earns Rltd Orgs	0	CompBsdNetEarnsRltdOrgsInd
Any Non Fixed Payments	0	AnyNonFixedPaymentsInd
Initial Contract Exception	0	InitialContractExceptionInd

Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (7 entries)

TitleTitleTxt	Base Compensation Filing OrgBaseCompensationFilingOrgAmt	Compensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmt	Bonus Filing OrganizationBonusFilingOrganizationAmount	Bonus Related OrganizationsBonusRelatedOrganizationsAmt	Other Compensation Filing OrgOtherCompensationFilingOrgAmt	Other Compensation Rltd OrgsOtherCompensationRltdOrgsAmt	Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt	Deferred Comp Rltd OrgsDeferredCompRltdOrgsAmt	Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt	Nontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmt	Total Compensation Filing OrgTotalCompensationFilingOrgAmt	Total Compensation Rltd OrgsTotalCompensationRltdOrgsAmt	Comp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmt	Comp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt
Mary B Maertens
President & CEO	$0	$294,295	$0	$0	$0	$62,650	$0	$19,332	$0	$24,659	$0	$400,936	$0	$0
Sharon Williams
Sec/Treas & VP Finance	$167,021	$0	$0	$0	$796	$0	$3,384	$0	$24,046	$0	$195,247	$0	$0	$0
Curtis Louwagie MD
Physician	$656,807	$0	$0	$0	$1,426	$0	$5,300	$0	$23,610	$0	$687,143	$0	$0	$0
Vikram Chatrath MD
Physician	$798,754	$0	$0	$0	$1,113	$0	$5,300	$0	$25,143	$0	$830,310	$0	$0	$0
Traci Kruse MD
Physician	$426,824	$0	$0	$0	$673	$0	$5,300	$0	$1,150	$0	$433,947	$0	$0	$0
Ajay Shalwala MD
Physician	$492,369	$0	$0	$0	$817	$0	$3,125	$0	$9,805	$0	$506,116	$0	$0	$0
Syed Hasan MD
Physician	$570,930	$0	$0	$0	$572	$0	$5,019	$0	$9,369	$0	$585,890	$0	$0	$0

Supplemental Information Detail SupplementalInformationDetail

Field	Value	IRS element (for citing)
Form And Line Reference	Schedule J, Part I, Line 3:	FormAndLineReferenceDesc
Explanation	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.	ExplanationTxt

Schedule L IRS990ScheduleL

Loans Btwn Org Interested Prsn LoansBtwnOrgInterestedPrsnGrp (4 entries)

Relationship With OrgRelationshipWithOrgTxt	Loan PurposeLoanPurposeTxt	Loan From OrganizationLoanFromOrganizationInd	Original PrincipalOriginalPrincipalAmt	Balance DueBalanceDueAmt	DefaultDefaultInd	Board Or Committee ApprovalBoardOrCommitteeApprovalInd	Written AgreementWrittenAgreementInd
Dr Vikram Chatrath
Employee	Community needs loan	Yes (X)	$200,000	$90,000	0	0	Yes (1)
Dr Syed Mustafa Hasan
Employee	Community needs loan	Yes (X)	$100,000	$52,083	0	0	Yes (1)
Dr Traci Kruse
Employee	Community needs loan	Yes (X)	$250,000	$10,417	0	0	Yes (1)
Dr Ajay Shalwala
Employee	Community needs loan	Yes (X)	$100,000	$52,083	0	0	Yes (1)

Field	Value	IRS element (for citing)
Total Balance Due	$204,583	TotalBalanceDueAmt

Bus Tr Involve Interested Prsn BusTrInvolveInterestedPrsnGrp

Name Of Interested NameOfInterested

Field	Value	IRS element (for citing)
Person	Melissa Younger	PersonNm

Field	Value	IRS element (for citing)
Relationship Description	Family member of board member, Randy Serreyn	RelationshipDescriptionTxt
Transaction	$115,883	TransactionAmt
Transaction	Employee compensation	TransactionDesc
Sharing Of Revenues	0	SharingOfRevenuesInd

Schedule O IRS990ScheduleO

Supplemental Information Detail SupplementalInformationDetail (15 entries)

Form And Line ReferenceFormAndLineReferenceDesc	ExplanationExplanationTxt
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.

Schedule R IRS990ScheduleR

Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (17 entries)

Address Line1USAddress/AddressLine1Txt	CityUSAddress/CityNm	State AbbreviationUSAddress/StateAbbreviationCd	ZIPUSAddress/ZIPCd	EINEIN	Primary ActivitiesPrimaryActivitiesTxt	Legal Domicile StateLegalDomicileStateCd	Exempt Code SectionExemptCodeSectionTxt	Public Charity StatusPublicCharityStatusTxt	Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt	Controlled OrganizationControlledOrganizationInd	Direct Controlling NADirectControllingNACd
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		0	N/A
Avera Marshall Foundation
300 S Bruce Street	Marshall	MN	56258	411784801	Fundraising	MN	501(c)(3)	Line 7	Avera Marshall	Yes (1)
Avera Tyler
240 Willow Street	Tyler	MN	56178	410853163	Healthcare Services	MN	501(c)(3)	Line 3	Avera Marshall	Yes (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

Id Related Org Txbl Partnership IdRelatedOrgTxblPartnershipGrp (9 entries)

Address Line1USAddress/AddressLine1Txt	CityUSAddress/CityNm	State AbbreviationUSAddress/StateAbbreviationCd	ZIPUSAddress/ZIPCd	EINEIN	Primary ActivitiesPrimaryActivitiesTxt	Legal Domicile StateLegalDomicileStateCd	Direct Controlling NADirectControllingNACd	Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt	Predominant Income TypePredominantIncomeTypeTxt	Share Of Total IncomeShareOfTotalIncomeAmt	Disproportionate AllocationsDisproportionateAllocationsInd	General Or Managing PartnerGeneralOrManagingPartnerInd	OwnershipOwnershipPct
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	$87,796	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

Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp (6 entries)

Address Line1USAddress/AddressLine1Txt	CityUSAddress/CityNm	State AbbreviationUSAddress/StateAbbreviationCd	ZIPUSAddress/ZIPCd	EINEIN	Primary ActivitiesPrimaryActivitiesTxt	Legal Domicile StateLegalDomicileStateCd	Direct Controlling NADirectControllingNACd	Entity TypeEntityTypeTxt	Controlled OrganizationControlledOrganizationInd
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

Field	Value	IRS element (for citing)
Receipt Of Int Annts Rnts Rylts	0	ReceiptOfIntAnntsRntsRyltsInd
Gift Grnt Or Cap Contri To Oth Org	0	GiftGrntOrCapContriToOthOrgInd
Gift Grnt Cap Contri From Oth Org	Yes (1)	GiftGrntCapContriFromOthOrgInd
Loans Or Guarantees To Other Org	0	LoansOrGuaranteesToOtherOrgInd
Loans Or Guarantees From Oth Org	0	LoansOrGuaranteesFromOthOrgInd
Div Related Organization	0	DivRelatedOrganizationInd
Asset Sale To Other Org	0	AssetSaleToOtherOrgInd
Asset Purchase From Other Org	0	AssetPurchaseFromOtherOrgInd
Asset Exchange	0	AssetExchangeInd
Rental Of Facilities To Oth Org	Yes (1)	RentalOfFacilitiesToOthOrgInd
Rental Of Fclts From Oth Org	Yes (1)	RentalOfFcltsFromOthOrgInd
Perform Of Services For Oth Org	Yes (1)	PerformOfServicesForOthOrgInd
Perform Of Services By Other Org	Yes (1)	PerformOfServicesByOtherOrgInd
Sharing Of Facilities	Yes (1)	SharingOfFacilitiesInd
Paid Employees Sharing	Yes (1)	PaidEmployeesSharingInd
Reimbursement Paid To Other Org	Yes (1)	ReimbursementPaidToOtherOrgInd
Reimbursement Paid By Other Org	Yes (1)	ReimbursementPaidByOtherOrgInd
Transfer To Other Org	Yes (1)	TransferToOtherOrgInd
Transfer From Other Org	Yes (1)	TransferFromOtherOrgInd

Transactions Related Org TransactionsRelatedOrgGrp (2 entries)

Transaction TypeTransactionTypeTxt	InvolvedInvolvedAmt	Method Of Amount DeterminationMethodOfAmountDeterminationTxt
Avera Marshall Foundation
C	$1,167,024	General ledger
Avera Marshall Foundation
S	$3,748,683	FMV of assets from dissolution

Supplemental Information Detail SupplementalInformationDetail (2 entries)

Form And Line ReferenceFormAndLineReferenceDesc	ExplanationExplanationTxt
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.