2017-05-10T15:11:24-05:00 2016-06-30 450250958 Eide Bailly LLP 800 Nicollet Mall Ste 1300 Minneapolis MN 554027033 990 2015-07-01 420680370 Avera Holy Family AVER 7123626519 826 North 8th Street Estherville IA 51334 Dale Hustedt President & CEO 7123626519 2017-05-10 1 Kim Hunwardsen CPA P00484560 6122536500 2017-05-10 2015 2021-01-29 14:40:06Z Dale Hustedt 826 North 8th Street Estherville IA 51334 26923647 0 0928 X www.avera-holyfamily.org X 1996 IA Promotion of Health 10 10 245 12 2816 711 41213 50796 24936162 26591958 480572 241151 36557 39742 25494504 26923647 33316 27774 0 0 12232029 12852583 0 0 0 11064874 12089654 23330219 24970011 2164285 1953636 37324543 37957631 7535705 6659111 29788838 31298520 X Avera is a health ministry rooted in the Gospel. Our mission is to make a positive impact in the lives and health of persons and communities by providing quality services guided by Christian values. 0 0 22093189 27774 26591958 Avera Holy Family Health operates a 25-bed critical access hospital and provider-based clinic located in Estherville, Iowa. Inpatient and outpatient medical services are provided. The hospital provided 2,463 inpatient bed days.Avera Holy Family maintains records to identify and monitor the level of charity care it provides. These records include the amount of charges foregone for services and supplies furnished under its charity care policy and equivalent service statistics. The amount of charges foregone, based on established rates, were $407,510 for the year ended June 30, 2016.The Hospital also provides community benefit health activities at less than or at no cost to support those in the area served. These activities include community education programs; special programs for the elderly, handicapped, and medically underserved; and a variety of broad community support activities. For the years ended June 30, 2016, specific activities included meals delivered to residential homes; meeting facilities; and programs for patients and families suffering from cancer, diabetes, breathing disorders, and others; assistance to health educators; emergency health care providers; and wellness programs. 22093189 1 1 0 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 0 0 0 0 0 0 0 0 1 1 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 1 53 0 1 245 1 1 1 0 0 0 0 0 0 0 0 0 X 10 10 0 0 0 0 1 1 1 1 0 0 0 1 1 1 1 1 1 0 0 1 0 X Shannon Adams 7123626519 826 N 8th Street Estherville IA 51334 Joe Fitzgibbons Chair 1.00 0.00 X X 0 0 0 Joe Greig Vice Chair 1.00 0.00 X X 0 0 0 Dr Anthony Cook Board Member 1.00 0.00 X 0 0 0 Sr Debra Kolecka Board Member 1.00 5.50 X 0 0 0 Sr Mary Jaeger Board Member 1.00 10.00 X 0 0 0 Chris Schiltz Board Member 1.00 0.00 X 0 0 0 Kathy Preston Board Member 1.00 0.00 X 0 0 0 Sr Sharon Haas Board Member 1.00 0.00 X 0 0 0 Roslyn Gunderson Board Member 1.00 0.00 X 0 0 0 Scott Stokes Board Member 1.00 0.00 X 0 0 0 Dale Hustedt President & CEO 40.00 0.00 X 0 156989 23189 Shannon Adams Sec/Treas & SrVP Finance 45.00 1.00 X 0 97234 22714 Kristi Hough Pharmacy Manager 40.00 0.00 X 126594 0 3356 April Krull Pharmacist 40.00 0.00 X 105208 0 18011 231802 254223 67270 2 0 1 0 Estherville Medical Center ER 926 N 8th Street Estherville IA 51334 ER Coverage 595736 Acute Care Inc PO Box 4130 Des Moines IA 50333 ER Coverage 455694 Woodward Anesthesia Services PC 203 N 8th St Estherville IA 51334 Anesthesia Services 298249 Fit for Life Physical Therapy LLC 826 N 8th Estherville IA 51334 Physical Therapy 264934 Grapetree Medical Staffing 703 16th Street Spirit Lake IA 51360 Staffing 207605 7 28921 21875 50796 Patient Service Revenu 622110 25481822 25481822 Other Revenue 900099 912553 909737 2816 Change in Foundation 900099 71904 71904 Cafeteria 900099 50024 50024 Collaborative Agreement 900099 48655 48655 27000 27000 26591958 11227 11227 39742 0 39742 39742 39742 214992 14932 0 0 214992 14932 229924 229924 26923647 26589142 2816 280893 27774 27774 10030783 8969531 1061252 531730 98429 433301 1618621 1423520 195101 671449 607499 63950 362088 30000 332088 35700 35700 1769022 1728556 40466 36010 471 35539 362112 207157 154955 141865 79460 62405 379351 379351 20158 11297 8861 81860 70585 11275 104408 104408 1526487 1526487 329375 70551 258824 Medical Supplies 4093682 4093682 Locum Fees 1180412 1180412 Bad Debt Expense 1014242 1014242 UBI Tax 102 102 652780 469675 183105 24970011 22093189 2876822 0 3289110 2965166 3545567 3481778 3125 749685 716064 145061 159508 29586529 16076909 13240052 13509620 293480 296976 15680663 15935234 198013 247052 179787 646233 37324543 37957631 1886891 1828403 3246414 3010157 55049 2347351 1820551 7535705 6659111 X 29535949 31029292 230347 246686 22542 22542 29788838 31298520 37324543 37957631 X 1953636 -259951 -184003 X X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 908995 146759 1055754 823825 85170 908995 721217 102608 823825 680404 40813 721217 680404 680404 0.96120 0.02140 0.01740 0 1 1 470340 470340 17293189 9214596 8078593 10657715 6586524 4071191 1165285 275789 889496 13509620 Assets Lmited as to Use - Avera Pooled Investments 13943357 F Investment in Foundation 1991877 F 15935234 Due to Related Party 1250000 Clinic Collaborative Arrangement 570551 1820551 X 25633115 -259951 -1014242 -1274193 26907308 16339 16339 26923647 23955769 0 23955769 1014242 1014242 24970011 Part V, Line 4: The Organization's endowments consist of a portion of their interest in the net assets of the Avera Health Foundation. The Avera Health Foundation includes endowment funds which have been established for a variety of purposes. As required by generally accepted accounting principles, net assets associated with endowment funds, including funds designated by the Board of Directors to function as endowments (if any), are classified and reported based on the existence or absence of donor-imposed restrictions. Part X, Line 2: The Organization is an Iowa nonprofit corporation and has been recognized by the Internal Revenue Service (IRS) as exempt from federal income taxes under Internal Revenue Code Section 501(c)(3). The Organization is annually required to file a Return of Organization Exempt from Income Tax (Form 990) with the IRS. In addition, the Organization is subject to income tax on net income that is derived from business activities that are unrelated to its exempt purpose. The Organization files an Exempt Organization Business Income Tax Return (Form 990T) with the IRS to report its unrelated business taxable income. The Organization believes that it has 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 Organization's federal Form 990T filings are no longer subject to federal tax examinations by tax authorities for years before 2013. Part XI, Line 2d - Other Adjustments: Provision for Bad Debts Reported in Revenue on Financial Statements -1,014,242. Part XI, Line 4b - Other Adjustments: Change in Interest in Net Assets Avera Health Fdtn in Fund Balance for F/S 16,339. Part XII, Line 4b - Other Adjustments: Provision for Bad Debts Reported in Revenue on Financial Statements 1,014,242. 1 1 X 1 X 1 X 1 1 1 0 1 1 1142 232000 232000 0.00970 2807388 2195194 612194 0.02560 1142 3039388 2195194 844194 0.03530 10 600 52407 52407 0.00220 2 54 86156 86156 0.00360 2 172 422594 422594 0.01760 4 47676 47676 0.00200 18 826 608833 608833 0.02540 18 1968 3648221 2195194 1453027 0.06070 2 816 37424 37424 0.00160 1 74149 74149 0.00310 1 1005 1005 0.00000 4 816 112578 112578 0.00470 1 1014242 0 11667487 11734078 -66591 X 1 1 1 1 Avera Holy Family Health 826 N 8th Street Estherville IA 51334 www.avera-holyfamily.org 320014H X X X X Provider Based Clinic Avera Holy Family 1 0 0 1 X X X X X X X X X 15 1 0 0 1 X www.avera.org/holy-family-hospital X See Part V statement X 1 15 1 See Part V statement 0 0 1 X 150.000000000000 400.000000000000 X X X X 1 1 X X X 1 X http://www.avera.org/experience/ah/financial-assistance-charity-care/ X http://www.avera.org/experience/ah/financial-assistance-charity-care/ X http://www.avera.org/experience/ah/financial-assistance-charity-care/ X X X X X X 1 X 0 X X X X X 1 X 0 1 Avera Holy Family Part V, Section B, Line 5: Avera Holy Family utilized data gathered through input from community partners and services groups, survey responses, community leader interviews, and results from focus groups. Avera Holy Family and Emmet County Public Health collaborated with a number of community partners in the completion of the community health needs assessment. Multiple sources of data were analyzed in the needs assessment including public health reports, U.S. Census data related to population, housing and economics, and other labor force data. A community health needs assessment survey was conducted using Survey Monkey. Community input was gathered through community partners and service groups who represent the broad interests of the community. The following groups were involved in the community health needs assessment: Emmet County Public Health; Avera Holy Family Medical Staff; Emmet County Wellness Coalition; the Free Clinic Board; Nursing Home Leaders; Fire, Law Enforcement, Ambulance and Support Services (FLEAS); Compass Pointe Alcohol, Drug & Gambling Behavioral Health Services; and Emmet County Mental Health. Members from these community groups participated in meetings and/or completed a community health needs survey. Avera Holy Family Part V, Section B, Line 11: Significant health needs of the community identified during the 2016 Community Health Needs Assessment include: Obesity, Diabetes, Cardiovascular Disease, and Falls in Older Adults. Avera Holy Family will work with community partners as listed in the Community Needs Assessment Implementation Plan to address these health needs.The following health needs will not addressed:Need-Transportation Reason-Competing priorities and projectsNeed-Mental Health ServicesReason-Lack of professional resources & competing priorities and projectsNeed-Alcohol consumptionReason-Need being addressed by another community partner Avera Holy Family 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 Holy Family Part V, Section B, Line 16i: A summary of the financial assistance policy is posted in the Hospital facility's emergency rooms, 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 Holy Family 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 Holy Family 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 Holy Family 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: www.avera.org/about/community-health-needs-assessments/ 2 1 - Avera Parkwood Independent Living Facili 400 Parkwood Drive Pierre SD 57501 Independent living 2 - Maryhouse 400 Parkwood Drive Pierre SD 57501 Long term care 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: Our 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 and Medicaid were converted to cost using an overall cost-to-charge ratio addressing all patient segments. Community health improvement services, health professions education, subsidized health services, research and cash and in-kind contributions are reported based on actual expenses recorded to the general ledger. Part I, Ln 7 Col(f): The amount of bad debt removed from the denominator of the calculation was $1,014,242. Part II, Community Building Activities: The Organization supports the free clinic in the community; conducts public health screenings; participates in community health fairs; provides health education to community and schools; conducts a lifestyle challenge for the community; donates to various community organizations and health care scholarships; provides tours for school children; utilizes telecare; and provides Meals on Wheels. Part III, Line 4: The footnote to the Organization's financial statements that describes bad debt expenses can be found on pages 7 and 8 of the attached financial statements. Part III, Line 8: Medicare allowable costs of care are based on the Medicare cost report. The Medicare cost report is completed based on the rules set forth by Centers for Medicare and Medicaid Services. Avera Holy Family follows the CHA guidelines in reporting community benefits and therefore any Medicare shortfall is excluded from our community benefit report. However, Medicare is the Organization's largest payer and patients with Medicare coverage are accepted regardless of whether or not a surplus or deficit is realized from providing the services. This basis therefore means providing Medicare services promotes access to healthcare services which is a key advantage for our community. 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 Organization collaborated with the Department of Public Health on a needs assessment. The finalized Community Health Needs Assessment and Implementation Strategy is located on our website. Part VI, Line 3: Information regarding charity care is made available to patients via their billing statements. The Finance Department also informs patients of the policy through their contact with patients. Brochures regarding financial assistance are located in the lobby of the Hospital and the Clinic. Part VI, Line 4: Avera Holy Family Health operates a 25-bed critical access hospital and provider-based clinic located in Estherville, Iowa. Avera Holy Family's service area includes Emmet County and surrounding counties in Iowa. In 2014, the population for Emmet County was 9,990. Approximately 19.2% of the population is age 65 or older. The average per capita income is $28,293 and approximately 11.3% of the population is below the federal poverty level. The nearest hospital in the area is approximately 15 miles from Avera Holy Family's main campus. 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.The Organization supports the free clinic in the community; conducts public health screenings; participates in community health fairs; provides health education to community and schools; conducts a lifestyle challenge for the community; donates to various community organizations and health care scholarships; provides tours for school children; utilizes telecare; and provides Meals on Wheels. 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. 0 0 0 0 0 0 0 0 0 Dale Hustedt President & CEO 0 154930 0 0 0 2059 0 2531 0 21432 0 180952 0 0 Schedule J, Part I, Line 3: The President/CEO's compensation is paid by a related organization, Avera Health. Avera St. Luke's relied on the related organization for determining the compensation for the President/CEO using the methods described in Part I, Line 3. A The City of Estherville Iowa 426004647 297542BG6 2012-06-21 3840000 Refund the Series 2000 Bonds issued 12/14/2000 0 0 0 A 725000 3840000 76800 3763200 2000 1 0 1 1 A 0 0 0 0 0.00000 0.00000 0.00000 0 0 0 A 0 0 0 0 0 0 0 0 0 A 0 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 the 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, SD ("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 CEO of the Corporation; 8) To approve the 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 Member; 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 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 CEO reviews the 990 in detail. After the CEO's review, the 990 is provided to each Board Member. 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 15 The CEO and officers are compensated by Avera McKennan. Avera McKennan has a process in place for determining compensation for these individuals. Form 990, Part VI, Section C, line 19 The organization's governing documents and conflict of interest policy are not 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 XI, line 9: Equity Transfers -184,003. Form 990, Part XII, Line 2c: The Audit Committee of Avera Health, parent organization, selects the auditor and reviews the audited financial statements for Avera Holy Family. Form 990, Part VI, Section B, Line 16b: There is no written policy or procedure since 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. 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 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 1 Avera St Anthony's Hospital 300 N 2nd Street ONeill NE 68763 470463911 Healthcare Services NE 501(c)(3) Line 3 Avera Health 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 401 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 Street 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 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 Marshall 300 S Bruce St Marshall MN 56258 410919153 Healthcare Services MN 501(c)(3) Line 3 Avera Health 0 Avera Marshall Foundation 300 S Bruce St Marshall MN 56258 411784801 Fundraising MN 501(c)(3) Line 7 Avera Marshall 0 Avera Gettysburg 606 East Garfield Gettysburg SD 57442 460234354 Healthcare Services SD 501(c)(3) Line 3 Avera St Mary's 0 Avera St Mary's 801 East Sioux Avenue Pierre SD 57501 460230199 Healthcare Services SD 501(c)(3) Line 3 Avera Health 0 Avera Tyler 240 Willow Street Tyler MN 56178 410853163 Healthcare Services MN 501(c)(3) Line 3 Avera Marshall 0 Avera Health Plans Inc 3900 W Avera Drive Suite 101 Sioux Falls SD 57108 460451539 Health Financing and Health Plan Admin SD 501(c)(4) Avera Health 0 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 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 Avera Home Medical Equipment of Spencer Hospital LLC 2400 S Minnesota Av 102 Sioux Falls SD 57117 800619999 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 Heart Hospital of South Dakota LLC 10720 Sikes Place Suite 300 Charlotte NC 28277 562143771 Healthcare Services NC N/A Brookings Health System - Avera HME LLC 101 22nd Ave Suite 101 Brookings SD 57006 453204123 Medical services - Home Medical Equipment SD N/A Accounts Management Inc 5132 S Cliff Avenue Suite 101 Sioux Falls SD 57108 460373021 Collection Agency SD N/A C 0 Avera Property Insurance Inc 510 W 23rd Street 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 Inc 2600 W 49th Street Sioux Falls SD 57105 460401087 Insurance SD N/A C 0 DakotaCare Administrative Services Inc 2600 W 49th Street Sioux Falls SD 57105 460424322 Insurance SD N/A C 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 Schedule R, Part II: Effective October 1, 2015, Avera Health Plans Inc. obtained tax exempt status under IRC 501(c)(4). Avera Health Plans Inc. was previously taxed as a C-corporation. Effective March 1, 2016, Avera Tyler was acquired by Avera Health. Schedule R, Part III: Avera Home Medical Equipment of Estherville, LLC dissolved effective October 1, 2015. Avera Home Medical Equipment of Marshall, LLC dissolved effective January 1, 2016. Operations of both entities were transferred to Avera @ Home.