2026-05-15T09:25:53-05:00 2025-06-30 450250958 Eide Bailly LLP 800 Nicollet Mall Ste 1300 Minneapolis MN 554027033 990 2024-07-01 410919153 Avera Marshall AVER 5075329661 300 S Bruce Street Marshall MN 562581934 Julie Lautt CFO Avera Health 5075329661 2026-05-11 1 1 Kim Hunwardsen CPA P00484560 6122536500 2026-05-11 2024 2025-03-06 01:10:19Z Avera Marshall Regional Medical Center Debbie Streier 300 S Bruce Street Marshall MN 562581934 162870065 0 X www.avera.org X 1944 MN Promotion of health 11 7 905 19 24186 14301 407857 888919 150368471 160518140 469295 967868 169180 408551 151414803 162783478 35813 3969 0 0 70266125 73974825 0 0 1291 76726263 84111958 147028201 158090752 4386602 4692726 101603031 103310659 28220083 23825079 73382948 79485580 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 144628164 3969 160759117 Avera Marshall's mission is to provide healthcare services to Marshall, Minnesota residents and residents of the surrounding area. Avera Marshall is a 501(c)(3) organization affiliated with Avera Health. Avera Marshall consists of a 25-bed critical access hospital plus 10 behavioral health beds and a 76-bed nursing home in Marshall, Minnesota, seven physician clinics and five optometry clinics. The program services offered include primary care, general surgery, audiology, ENT, cardiology, neurology (via telemed), endocrinology, dermatology, pediatrics, orthopedics, OB/GYN, urology, oncology, palliative care, pulmonology, podiatry, psychiatry, nephrology, radiology, optometry, ophthalmology, wound care, level III trauma center, ICU, speech therapy, physical therapy, and occupational therapy. Avera Marshall provides acute care and long-term healthcare services. Following is a breakdown of these statistics by facility:Avera Marshall Hospital 1,306 Acute patient discharges 343 Newborn patient discharges 4 Swing bed patient discharges 85,673 Outpatient visits 36 Swing-bed patient days 525 Newborn patient days 56,640 Clinic visitsAvera Morningside Heights Care Center 26,814 Long-term resident days 140 Long Term Care patient dischargesAvera Marshall maintains records to identify and monitor the level of charity care it provides. These records include the amount of charges forgone for services and supplies furnished under its charity care policy and equivalent service statistics. The amount of charges foregone, based on established rates, were $2,896,784.Avera Marshall also provides community benefit health activities at less than or at no cost to support those in the area serviced, see Schedule H. As a member of the Avera Health Network, Avera Marshall upholds the vision of the Presentation and Benedictine Sisters to work through collaboration to provide quality, effective health ministry and to improve the healthcare of individuals and our communities through a regionally integrated network of persons and institutions. Avera Marshall engages in activities designed to improve the health of individuals and communities in response to a calling to heal the sick, the elderly, and the oppressed. 144628164 1 1 0 1 0 0 0 0 1 1 1 1 0 0 1 1 0 1 0 0 0 0 0 0 0 0 1 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 1 106 0 1 905 1 1 1 0 0 0 0 0 0 0 0 0 0 0 X 11 7 1 0 0 0 1 1 1 1 0 0 0 1 1 1 1 1 1 0 1 0 MN X Jamie Schaefer 6053223992 3900 W Avera Dr Ste 300 Sioux Falls SD 57108 Debbie Streier Regional President & CEO 40.00 6.00 X X 0 578020 18180 Amanda Sieling Chair 1.50 1.50 X X 0 0 0 Karie Novak Board Member 1.50 1.50 X 0 0 0 Rhonda Wiering - Board Member (Beg Jan)/AAH VP Clinical Growth 1.50 41.50 X 0 155368 42847 Greg Goepferich Board Member (Through Dec.) 1.50 1.50 X 0 0 0 Sharon Hennen Board Member 1.50 1.50 X 0 0 0 Tom Lorang Ed D Board Member/System Member 1.50 1.50 X 0 0 0 LaVonne Koenen Board Member 1.50 3.50 X 0 0 0 Curtis Louwagie MD Board Member/Opthalmology 41.50 1.50 X 1003068 0 59664 Tim O'Leary Board Member 1.50 1.50 X 0 0 0 Jill Vroman DO Vice Chair/Family Medicine/OB 41.50 1.50 X X 468028 0 52638 Sr Jodie Zimmerman Board Member 1.50 1.50 X 0 0 0 Julie Lautt CFO Avera Health;Secretary/Treasurer 0.10 46.30 X 0 1274363 20218 Emmy Ho MD Orthopedics & Surgery 40.00 0.00 X 920179 0 51916 Ajay Shalwala MD Ophthalmology 40.00 0.00 X 835686 0 29907 Jonna Maas MD Internal Medicine & Hospitalist 40.00 0.00 X 751414 0 51085 Timothy Michals MD Pediatrics & Internal Medicine 40.00 0.00 X 648919 0 18180 Arthur Rillo MD Family Medicine/OB 40.00 0.00 X 700295 0 52408 5327589 2007751 397043 151 0 1 0 Avera Health 3900 W Avera Drive Sioux Falls SD 57108 Shared Services 13823607 Big Stone Therapies Inc 500 Cross St Big Stone City SD 57216 Therapy Services 6524277 Journey Group Companies 4500 W 58th St Sioux Falls SD 57108 Construction Services 1442654 AMN Healthcare Inc 2735 Collection Center Dr Chicago IL 60693 Labor Services 1102943 GQR Recruiting Resources LLC 316 W 12th St Austin TX 78701 Locum Services 674621 32 233109 651749 4061 888919 Net Patient Service Revenue 621110 140767493 140743307 24186 Federally Qualified Health Center 621990 14190379 14190379 Pharmacy Revenue 456110 1405981 1405981 Patient and Clinic Revenue 621110 15884 15884 4138403 4138403 160518140 41731 41731 150584 7196 143388 143388 143388 992328 13200 0 79391 992328 -66191 926137 926137 A/R Interest 900099 254633 254633 Sports Programs 900099 10530 10530 265163 162783478 160759117 24186 1111256 X 3969 3969 1834436 1834436 58844403 57433045 1411358 2169414 2123014 46400 7314279 7182241 132038 3812293 3711824 100469 277430 277430 7752 7752 38166053 29621871 8544182 4297 2817 1480 707275 516224 191051 718255 705355 12900 2341086 1940903 400183 921813 910228 11585 232749 231993 756 509502 462078 47424 6048350 5656938 391003 409 153357 126316 27041 Medical Supplies 30334447 30307342 26223 882 Equipment Lease/Rental 131285 130823 462 3558307 1726747 1831560 158090752 144628164 13461297 1291 1033965 360249 17564495 20614746 3306368 3455230 1178532 974683 119185034 71541611 49390684 47643423 23641781 24039905 1756599 1998642 350000 350000 3380607 3873781 101603031 103310659 11014307 8296779 210809 15392 11681 13321 12283499 13223777 4699787 2275810 28220083 23825079 X 69361923 74975606 4021025 4509974 73382948 79485580 101603031 103310659 X 4692726 1032201 377705 X X 0 1 X 1 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 7752 7752 0 Part II-B, Line 1: Avera Marshall paid dues to organizations which have a portion of the dues attributed to lobbying activities. 0 1 X 713258 36444 78082 22531 805253 757268 15800 74883 134693 713258 711109 1106 49515 4462 757268 794733 7201 -82336 8489 711109 685848 119848 10963 794733 0.00000 0.62459 0.37541 0 1 1 1004636 1004636 76932416 43616094 33316322 72632 40177 32455 37514711 26798948 10715763 3660639 1086392 2574247 47643423 Avera Pooled Investments 19363113 F Interest in Avera Health Foundation 4676792 F 24039905 Estimated Third-Party Payor Settlements 1595230 Right of Use Operating Lease Obligations 200354 Other Liabilities 229 Intercompany Liabilities 479997 2275810 X Part IV, Line 2b: The Organization holds funds on behalf of its residents. 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: 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 consolidated 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. 1 1 X 1 X 250.000000000000 1 X 1 1 1 0 1 1 993311 993311 0.00630 4041896 3070085 971811 0.00610 5035207 3070085 1965122 0.01240 688827 177856 510971 0.00320 539306 539306 0.00340 15884060 9536783 6347277 0.04010 125903 125903 0.00080 17238096 9714639 7523457 0.04750 22273303 12784724 9488579 0.05990 1000 1000 0.00000 303961 276 303685 0.00190 34848 34848 0.00020 339809 276 339533 0.00210 1 1859141 0 27332897 26509886 823011 X 1 1 1 1 Avera Marshall Regional Medical Center 300 S Bruce Street Marshall MN 56258 See Part V Section C 00343 X X X X 6 Provider Based Clinics Avera Marshall 1 0 0 1 X X X X X X X X X 24 1 1 1 1 X See Part V Section C X See Part V Section C X 1 24 1 See Part V Section C 0 1 X 250.000000000000 400.000000000000 X X X X 1 1 X X X 1 X See Part V, Page 8 X See Part V, Page 8 X See Part V, Page 8 X X X X X X X 1 X 0 X X X X X 1 X 0 0 Avera Marshall Part V, Section B, Line 5: To develop the 2025 Community Health Needs Assessment (CHNA), the Avera Marshall Region gathered input directly from community members, public health representatives, and local organizations across Lincoln, Lyon, Chippewa, and Yellow Medicine counties. Feedback was collected through surveys, focus groups, and partnerships with local agencies to ensure that diverse voices were represented, including medically underserved and minority populations.A community survey consisting of eight questions was available for four weeks in March 2025, both online and in paper format. The paper version was distributed at the Avera Marshall Thrift Store and translated into Spanish to improve accessibility. A total of 154 residents completed the survey, sharing perspectives on personal and community health, barriers to care, and ideas for improvement.Two focus groups provided deeper insight into community needs. One group, held in April 2025, included members of the white ethnic community representing education, law enforcement, and social services. The second, held in December 2024, included women from the Karen community, one of the largest minority groups in the region. Participants discussed mental health, transportation, access to care, interpreter services, and provider communication.In addition, Southwest Health and Human Services (SWHHS) shared its 2024 health report and provided input on community health priorities. Input was also gathered from community health workers, faith leaders, and local employers of minority populations. Avera Marshall Part V, Section B, Line 6a: The Avera Marshall region has three hospitals: Avera Marshall, Avera Tyler, and Avera Granite Falls. As it is that all three hospitals are in the Avera Health system, share equally the same demographic and geographic area, and have shared senior leadership, the conducted CHNA was a regional CHNA that was inclusive of all three hospitals. Additionally, the implementation plan established applies to all three facilities. Avera Marshall Part V, Section B, Line 6b: Southwest Health and Human Services Avera Marshall Part V, Section B, Line 11: The community health needs assessment was completed during FY2025. The hospital has not taken specific actions with respect to the FY2025 implementation strategy. The following community health priority areas were identified and the following actions will be taken by the hospital during future years. - Cancer - Dental Care - Mental HealthThe Avera Marshall Region developed a three-year implementation strategy to address priority health needs identified through the 2025 Community Health Needs Assessment (CHNA). The plan focuses on cancer, dental health, and mental health, with goals, resources, community partners, and measurable outcomes defined for each area.Cancer initiatives aim to keep patients closer to home, expand access to research trials, develop a high-risk breast cancer clinic, and increase education and fundraising for cancer care.Dental health goals include building partnerships with local dentists, providing oral health education through community health workers, and distributing dental kits to schools and local nonprofits.Mental health strategies emphasize collaboration with schools, social service agencies, and local organizations to strengthen youth and adolescent support, expand access to care, recruit staff, and develop creative therapeutic programs.Progress will be reviewed annually and shared in the next CHNA cycle. The implementation plan was approved by the boards of Avera Marshall, Avera Tyler, and Avera Granite Falls in September 2025 and is publicly available on the Avera website.Avera Marshall will not be directly addressing other areas of concern, such as aging problems, domestic violence and child abuse, heart disease, obesity, and housing issues, identified through the assessment process. While the leadership team recognizes that other concerns exist, the hospital does not have the resources or expertise to address at this time.Avera Marshall continued to address the community health needs identified in the community health needs assessment completed in FY2022. The following community health priority areas were identified: Cultural barriers that impact healthcare, including but not limited to interpretive services; Mental Health; and Transportation, as it relates to access for healthcare services. Avera Marshall Region, comprised of Avera Marshall, Avera Tyler and Avera Granite Falls, developed an implementation plan for each of these three priorities. Mental Health:Avera Marshall's goal around mental health will be to lower depression rates and engage in issues around suicide prevention. Partners we are working with: Public Health, Clergy, Community Groups, Southwest Mental Health, AMG general practice providers, schools, and AMG Mental health providers. Steps taken: - The Avera Medical Group continues to track mental health needs among inpatient and outpatient populations. Providers regularly discuss depression with patients and integrate mental health screening into ongoing service lines, including routine OB care. These actions reflect an enduring commitment to early detection, continuity of care, and integrated behavioral health across departments. - The Avera Marshall region continued its "Ask the Question" initiative with a sustained focus on supporting the mental health of veterans. - Our Karen community health worker is providing continuity of service for Karen patients referred to Southwest Mental Health. This continuity of service includes helping patients complete admitting paperwork and attending initial intake evaluation appointments. - Pediatric Patients and parents can participate in an approved Avera research study on pediatric mental health.Cultural barriers that impact healthcare, including but not limited to interpretive services:Avera Marshall's goal around cultural barriers is to improve interpretive services, aid in navigating the healthcare system, and educate our traditionally underserved populations in matters related to disease prevention and vaccinations. Partners we are working with: Public Health, Non-Avera Medical Providers, Churches, Community Groups, Local Employers, ARCH Language Network, and Avera Staff. Steps taken: - Avera maintains a continuous effort to expand access to in-person interpretation services for patients with limited English proficiency, recognizing the importance of cultural and linguistic responsiveness in health care. Efforts include having a Spanish speaking provider to provide in-person services, partnerships with Language Line and communication initiatives targeting Hispanic and Karen community members. - A Karen Community Health Worker (CHW) and Hispanic CHW continue to play an active role in outreach, health education, and interpretation. The CHW's certification and ongoing engagement exemplifies Avera's long-term commitment to cultural competency and equitable access to care. - Updated Religious Community Contact List to include religions other than Christianity. - Books from various religious traditions added to chapel, Muslim prayer rug now available. - Avera Marshall Region is developing a health promotion program for employees at the local meat processing facility in Marshall, Minnesota, which employs approximately 450 workers representing diverse ethnic communities, including Karen, Somali, and Hispanic populations. The program is being designed to address diabetes prevention and management among this workforce, who experience multiple social determinants of health challenges such as limited access to care, language barriers, and high occupational stress. - CMO provides oversight for occupational health requirements at Turkey Valley Farms. - System health equity initiative established, and regional VP of Mission is assigned as health equity lead. - Quality and Mission joined a Program with Stratis Health that has the goal to help Critical Access Hospitals (CAH) better understand how to bring Social Determinants of Health (SDOH) into operations. - The Clothed in Strength Program continues to operate year-round, providing essential clothing and supplies to patients in hospitals, long-term care facilities, and the broader community through the Avera Thrift Store. - The Dispensary of Hope project remains active regionwide, ensuring that low-income patients continue to have access to necessary medications through a sustainable, charitable distribution system. - The Avera Thrift Store collaborated with a wide network of local and international nonprofits, schools, faith communities, and service organizations to distribute clothing, household goods, and supplies to those experiencing need:Partner organizations included WRAP, UCAP, Central Africa Mission, Nan's Knits, Boulder Creek Assisted Living, Parkside Elementary, the Nigeria Supply Program (via Canby Catholic Church), Avera Tyler Sunrise Manor, Marshall Animal Clinic, Avera Marshall Behavioral Health Unit, Habitat for Humanity, Marshall High School, Lutheran World Relief, the Marshall High School Tennis Team, Go Creations, Reunited Halfway House, Southwest Health and Human Services, Western Mental Health, the Tyler Arts Council, Avera Morningside Heights, Holy Redeemer Catholic Church, Phase Industries, the Lyon County Master Gardeners, the Lakeside Companion Animal Clinic, Our Savior's Lutheran Church in Canby, Saint Edward's School, Saint Mary's Church, Canby Hospital, the Marshall Middle School Kindness Closet, Friends of the Library, Awake Journey, and Disabled American Veterans. Through these partnerships, the organization distributed a wide range of materials including clothing, shoes, blankets, towels, craft supplies, kitchenware, school items, vases, and sunglasses to support individuals and families in need, immigrants, students, and those in care facilities. Notable donations included 500 pairs of children's sunglasses to local parochial schools, 24 pairs of shoes to Disabled American Veterans, and CD players to hospice patients - Quality team to bring SDOH into their ongoing sepsis project. - The Avera Marshall Region continues several initiatives designed to provide lasting improvements in health access, equity, and community well-being. - New partnerships were initiated with leaders of the local Muslim community to explore culturally sensitive health promotion programs.Continued at the end of Schedule H, Part V narratives. 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 16j: 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 24: The hospital financial assistance policy does not cover elective procedures. The hospital may have charged FAP eligible patients gross charges for services that are not covered under the financial assistance policy. Part V, Section B, Lines 7a, 7b and 10a: avera.org/about/community-health-needs-assessments/ Part V, section B, Line 16a-c The FAP, FAP Application, and Plain Language Summary are available at:avera.org/patients-visitors/charity-patient-assistance-programs/financial-assistance-forms/ Part V, Section A website address: avera.org/locations/marshall/ Part V, Section B, Line 11 (Cont'd): Transportation, as it relates to access for healthcare services:Avera Marshall's goal is to improve transportation access for health care appointments for those who do not have transportation and develop stronger relationships with transportation services within our service area. Partners we are working with: Local and State Public Health, City of Marshall, United Community Action Partnership, Local Medical Transport Companies, and Avera Staff (Community Health Worker and Care Coordination). Steps taken: - Avera continues collaboration with the City of Marshall and public health partners to improve transportation access, including the addition of a bus stop at the Federally Qualified Health Center (FQHC) and partnerships with other agencies to ensure reliable transportation for medical appointments. These efforts represent a sustained commitment to addressing transportation as a social determinant of health. - Karen community health worker provides transportation coordination for Karen community as needed. This allows care coordination to focus on more complex cases and will allow the community health worker to provide more targeted intervention on transportation for Karen community members. - When emergency medical transportation is utilized, providing clear directions to family and friends of the patient to the destination facility. Additionally, when those family and friends do not have transportation have social work/care coordination find a local transport company to bring at least one family member to the destination facility. - Avera Marshall Region applied for a grant to expand special transportation services through Granite Falls Ambulance, with availability extending to the broader Marshall & Tyler communities. 8 1 - Avera Morningside Heights Care Center 300 S Bruce Street Marshall MN 56258 Nursing home 2 - Avera Therapy Marshall 1521 Carlson Street Marshall MN 56258 Physical, speech, and occupational therapy 3 - AMG Optometry Redwood Falls 500 E Bridge Street Redwood Falls MN 56283 Optometry, ophthalmology, optical 4 - AMG Optometry Tracy 505 State Street Tracy MN 56175 Optometry, ophthalmology, optical 5 - AMG Optometry Springfield 602 N Jackson Ave Springfield MN 56087 Optometry, ophthalmology, optical 6 - Heartland Eye Care Center - Canby 130 1st St W Suite 105 Canby MN 56220 Optometry, optical 7 - Heartland Eye Care Center - Dawson 878 6th St Dawson MN 56232 Optometry, optical 8 - AMG Occupational Medicine 1521 Carlson Street Marshall MN 56258 Clinic 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 community benefit report is prepared by a related organization, Avera Health, and is available to the public at https://www.avera.org/about/annual-report/. Part I, Line 7: Charity care was converted to cost using an overall cost-to-charge ratio addressing all patient segments. Unreimbursed Medicaid was calculated using the costing methods to prepare the cost report. Subsidized health services were calculated based on a combination of the Medicare cost report and actual expenses recorded to the general ledger. Community health improvement services, health professions education, and cash and in-kind contributions are reported based on actual expenses recorded to the general ledger. Part II, Community Building Activities: The organization provides education to community groups, has staff that serve on various committees/boards, pays the salaries of two police officers, provides leadership development and training for community members, and donates to various community organizations. Part III, Line 2: The amount on line 2 represents implicit price concessions. The Organization determines its estimate of implicit price concessions based on its historical collection experience with the respective class of patients and residents. Part III, Line 4: The footnote to the Organization's financial statements that describes implicit price concessions is located in the audited financial statement report on pages 18 and 19. Part III, Line 8: Avera Marshall provides services to patients under the Medicare program knowing they may 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, in years the costs associated with services provided under the Medicare programs are not completely covered, 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: Avera Marshall uses many sources to assess the needs of the community, including their medical staff's daily interactions with their patients and the community. Additional sources include federal, state, and county statistical information, public health data, internal data, and input from community members, businesses, city, and other local agencies. To gain community member input the following processes are used: interviews, focus groups, community health workers for the Karen and Spanish communities, neighborhood canvassing, and surveys. Other sources have included a Mission and Planning Board Committee and our full governing board that includes representatives from multiple service areas in the community, including academic, governmental, non-profit, industry, and vulnerable populations. Care is taken with all information sourcing to make sure we gain the perspective of the underserved populations: Karen, Hispanic/Latino, African American, and Somali. Avera Marshall also partners with many area organizations, including Southwest Health and Human Services (SWHHS,) where we share information, such as their annual Health Report. Part VI, Line 3: Uninsured patients who hold an inpatient status are counseled by a Patient Advocate to screen them for coverage eligibility and to assist in payer source enrollment. Those that are not eligible are provided a charity care application along with instructions on how to fill out the application. All patients receive statements that indicate who to contact should they need financial assistance. In addition, all patients receive a summary of financial assistance upon registration, as well as in their final statement. Should a patient contact Patient Financial Services and indicate inability to pay, they are transferred to a financial counselor to assist them with the financial assistance application process. Also, inpatient and same day surgery patients receive a brochure in their admissions packet. Pre-collection letters also include information regarding the financial assistance and uninsured programs. Part VI, Line 4: Avera Marshall is a 25-bed critical access hospital in Marshall, Minnesota, which includes an additional 10 behavioral health beds. The primary service area is defined as Lyon County, Minnesota, including the communities of Marshall, Minneota, Ghent, Taunton, Lynd, Russell, Cottonwood, Tracy, Balaton and Garvin. Marshall is the county seat. According to the U.S. Census Bureau Quick Facts 2025 data, the estimated population of Lyon County as of July 1, 2024 is 25,577 and is predominately white at 88.3%. It is estimated that 18.7% of the population is 65 years and over. The median household income is $75,303 with an 11.1% poverty rate. Uninsured individuals under age 65 is estimated at 6.2%. Part VI, Line 5: Avera Marshall is one of the largest employers in the area and is committed to helping its community members get as much of their healthcare as close to home as possible. To this end, any surplus funds are reinvested in facilities to improve patient care, add/replace necessary equipment, and fund needed facility upgrades. To further ensure local care, medical staff privileges are extended to all qualified physicians in the community. E-care services are invested in monthly to ensure provider coverage is available locally via video conference to the patient's room or local provider office for emergency, behavioral health, ICU, pharmacy, and long-term care coverage.In addition, Avera Marshall is the sole provider for hospital inpatient care, the only physician staffed 24/7 ER Level III Trauma offering coverage no matter the ability to pay, birthing center, and full-service surgery center. 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. Some of the other services include dialysis, in-home palliative care, and diabetic education. Avera Marshall is committed to taking care of all individuals, no matter their ability to pay. Financial assistance is always available for those with a diminished ability to pay. We staff patient advocates, who meet with patients with high deductible plans and high-cost medications to find drug programs to help cover a patient's out of pocket costs. We also work with patients to complete presumptive Medicaid, full Medicare applications, answer questions on the MNSure insurance programs, help patients coordinate their insurance benefits and complete financial assistance applications for Avera and Access Health services. In addition, on January 1, 2022, Avera Marshall partnered with Rural Health Care Inc. to open Access Health-Marshall. This federally qualified health center clinic offers a full range of primary healthcare services. Avera Marshall offers a number of services that are free or low cost, including: childbirth classes, support groups, skin screening, Mother's Milk program (by purchasing donated breast milk and providing it to babies free of charge during their hospital stay), Planet Heart community screenings with reduced imaging fees in addition to free vein screenings, rape and sexual assault services not fully funded by the county, Hospice medical provider not billed to patients, sharps and unused medical disposal services, recycle eye wear program, transportation vouchers for patients without other options, physicals for sports are given to students who have no means to pay but wish to participate in athletic school activities, impact testing is provided to local schools to help support concussion testing and ensure student athletes do not return before they are ready, basic supply items are donated to school nurse providers for triage care, and in partnership with Big Stone Therapies, Avera Marshall provides athletic trainers to many high schools throughout the Marshall region with reduced cost to the school district. Avera Marshall also supports the local college, Southwest Minnesota State University with their medical needs for both students and athletes, including a medical director. Avera Marshall supports the local hockey program at the Red Baron Arena by providing volunteer medical coverage from local providers during weekend tournaments. This medical coverage for the facility must be EMT or higher. Community out-reach programs are done in partnership with local underserved communities and businesses. Avera hired a community health worker to support the Karen community by helping to coordinate their health needs and provide in-person interpretation services. In addition, virtual and other in person interpretation services are offered in several different languages. Staff Care Coordinators are also employed to help high-need patients navigate their health care needs. Educational experiences for school-aged children, students needing work study experience, and med student internships are offered. On an annual basis Avera Marshall provides scholarships for medical students and high-school students. Avera Marshall partners with Minnesota West Technical & Community College to provide free space within the hospital from some of their clinical training programs. Avera Marshall also partners with the Transition-to-Work Program or Project SEARCH. This program allows local high-school students with significant intellectual disabilities to be employed in nontraditional, complex, and rewarding jobs, allowing them to gain real-life work experience in order to achieve competitive employment upon graduation. Avera Marshall supports Southwest Minnesota State University (SMSU) in their work to add a four-year bachelor's degree nursing program. Nursing leaders participate in the advisory committee working to develop the curriculum. Avera Marshall will also collaborate by sharing simulation lab equipment and space with SMSU. The organization's governing body is comprised of volunteer members who reside in the community. Avera Marshall's leadership team, physicians, and general staff are encouraged to participate in civic and community organizations. Avera Marshall also offers many opportunities for community members to volunteer within the hospital, long term care, home care and hospice. Finally, to further safety for the community residents and patients, Avera funds two police officers for the City of Marshall. Avera Marshall's Thrift Store impacts the community in a variety of ways. The store not only employs some of the disabled clients at Advanced Opportunities, but also donates thousands of pounds of fiber (clothing) to Advanced Opportunities. Advanced Opportunities then sells the fiber to help support their programs, which at current fiber rates would be over $60K. In addition, the store is able to donate to individuals in the community that cannot afford to pay for the items. The Thrift Store supports our judicial system by being an option for court ordered community service. The Thrift Store works with Project Turnabout to provide opportunities for those dealing with addiction to re-enter the workforce. Part VI, Line 6: Avera is a sponsored ministry of the Benedictine and Presentation Sisters. The communities in which Avera operates all have unique health and community benefit needs. In keeping with the Catholic Healthcare Association guidelines, each hospital strives to meet its community's identified needs. The corporate staff of Avera Health advocates for all members regarding community benefit related matters of state, regional and national importance. 0 0 0 0 0 0 0 0 0 Julie Lautt CFO Avera Health;Secretary/Treasurer 0 1226098 0 41964 0 6301 0 17250 0 2968 0 1294581 0 0 Curtis Louwagie MD Board Member/Opthalmology 650126 0 349427 0 3515 0 17250 0 42414 0 1062732 0 0 0 Emmy Ho MD Orthopedics & Surgery 848449 0 15000 0 56730 0 17250 0 34666 0 972095 0 0 0 Ajay Shalwala MD Ophthalmology 538214 0 269876 0 27596 0 17250 0 12657 0 865593 0 0 0 Jonna Maas MD Internal Medicine & Hospitalist 384206 0 333022 0 34186 0 17250 0 33835 0 802499 0 0 0 Arthur Rillo MD Family Medicine/OB 442659 0 134212 0 123424 0 17250 0 35158 0 752703 0 0 0 Timothy Michals MD Pediatrics & Internal Medicine 599269 0 48197 0 1453 0 17250 0 930 0 667099 0 0 0 Debbie Streier Regional President & CEO 0 550926 0 18936 0 8158 0 17250 0 930 0 596200 0 0 Jill Vroman DO Vice Chair/Family Medicine/OB 431339 0 29750 0 6939 0 17250 0 35388 0 520666 0 0 0 Rhonda Wiering - Board Member (Beg Jan)/AAH VP Clinical Growth 0 151224 0 2414 0 1730 0 8293 0 34554 0 198215 0 0 Schedule J, Part I, Line 3: President/CEO serves Avera Marshall, Avera Tyler, and Avera Granite Falls and was compensated by a related organization, 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. Form 990, Part VI, Section A, line 2 Julie Lautt and Debbie Streier have a business relationship. Julie Lautt and Rhonda Wiering have a business relationship. 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, as the sole member, 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 A, line 8b There are no committees with authority to act on behalf of the governing body. Form 990, Part VI, Section B, line 11b The Form 990 is prepared and reviewed by an independent accounting firm. The Form 990 is then reviewed by the Avera Health VP of Financial Reporting and Tax Manager. After initial internal review, the Form 990 is made available to various members of Avera Health Executive Management, including the Avera Health CFO, President/CEO and COO. In addition, the Form 990 is made available to the Facility CEO, other Operation Finance Leaders and the Facility Board members. 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 The CEO and CFO-Avera Health are compensated by Avera Health. Annually the Compensation Committee of Avera Health, which is comprised of the Caring for Life Catholic Health Ministries Members of Avera Health, meets with an independent consultant regarding fair market value of officers and key employees. The Compensation Committee approves all salaries based on comparable data and documents the basis for their decision in meeting minutes. 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 Purchased Services: Program service expenses 16,789,160. Management and general expenses 322,068. Fundraising expenses 0. Total expenses 17,111,228. Medical Professional Fees: Program service expenses 3,055,708. Management and general expenses 0. Fundraising expenses 0. Total expenses 3,055,708. Repairs & Maintenance: Program service expenses 2,801,475. Management and general expenses 69,613. Fundraising expenses 0. Total expenses 2,871,088. Centralized Services: Program service expenses 6,975,528. Management and general expenses 8,152,501. Fundraising expenses 0. Total expenses 15,128,029. Form 990, Part XI, line 9: Change in Interest in Avera Foundation -155,436. Change in Assets with Donor Restrictions 488,950. Other changes in net assets 44,191. 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 X, Line 20: Avera Marshall is part of the Avera Obligated Group which consists of Avera Health, Avera McKennan, Avera St. Luke's, Avera Queen of Peace, Avera Sacred Heart, Avera Marshall, Avera St. Mary's, Avera St. Anthony's, Avera St. Benedict, Avera Holy Family, Avera Tyler, Avera Granite Falls, Avera Gettysburg and Avera at Home. Avera Marshall was not allocated any share of the bond issue, and thus does not have an amount on line 20. Avera Health 3900 West Avera Drive Suite 300 Sioux Falls SD 57108 460422673 Healthcare Services SD 501(c)(3) Line 10 N/A 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 at Home 5300 S Broadband Lane Sioux Falls SD 57108 460399291 Home Services SD 501(c)(3) Line 10 Avera Health 0 Avera Health Plans Inc 3900 West Avera Drive Suite 101 Sioux Falls SD 57108 460451539 Health Financing and Health Plan Admin SD 501(c)(4) Avera Health 0 Avera Granite Falls 345 10th Ave Granite Falls MN 56241 843156881 Healthcare Services MN 501(c)(3) Line 3 Avera Marshall 1 Avera Tyler 240 Willow Street Tyler MN 56178 410853163 Healthcare Services MN 501(c)(3) Line 3 Avera Marshall 1 Avera Queen of Peace Hospital 525 North Foster Mitchell SD 57301 460224604 Healthcare Services SD 501(c)(3) Line 3 Avera Health 0 Avera St Anthony's Hospital 300 N 2nd Street ONeill NE 68763 470463911 Healthcare Services NE 501(c)(3) Line 3 Avera Health 0 Avera St Luke's 305 South State Street Aberdeen SD 57401 460224598 Healthcare Services SD 501(c)(3) Line 3 Avera Health 0 Avera St Mary's 801 East Sioux Avenue Pierre SD 57501 460230199 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 Holy Family 826 N 8th Street Estherville IA 51334 420680370 Healthcare Services IA 501(c)(3) Line 3 Avera Health 0 Holy Family Hospital Foundation 826 N 8th Street Estherville IA 51334 421317452 Support of Health Related Services IA 501(c)(3) Line 10 Avera Holy Family 0 Sacred Heart Health Services 501 Summit Street Yankton SD 57078 460225483 Healthcare Services SD 501(c)(3) Line 3 Avera Health 0 Lewis and Clark Health Education and Service Agency 1000 W 4th Street Suite 9 Yankton SD 57078 460337013 Healthcare Services SD 501(c)(3) Line 10 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 Avera Home Medical Equipment of Floyd Valley Hospital LLC 5300 S Broadband Lane Sioux Falls SD 57108 820582350 Medical Services - Home Medical Equipment SD N/A 0 0 Avera Home Medical Equipment of Lakes Regional Healthcare LLC 5300 S Broadband Lane Sioux Falls SD 57108 862949748 Medical Services - Home Medical Equipment SD N/A 0 0 Avera Home Medical Equipment of Sioux Center LLC 5300 S Broadband Lane Sioux Falls SD 57108 753203100 Medical Services - Home Medical Equipment SD N/A 0 0 Avera Home Medical Equipment of Spencer Hospital LLC 5300 S Broadband Lane Sioux Falls SD 57108 800619999 Medical Services - Home Medical Equipment SD N/A 0 0 Brookings Health System - Avera HME LLC 100 22nd Ave Suite 101 Brookings SD 57006 453204123 Medical services - Home Medical Equipment SD N/A 0 0 Caravan Health ACO 15 LLC dba Prairie Vista Care Organization 20 Burton Hills Blvd Ste 100 Nashville TN 37215 611843657 Accountable Care Organization MO N/A 0 0 Caravan Health ACO 41 LLC dba Prairie View Care Organization 20 Burton Hills Blvd Ste 100 Nashville TN 37215 821447782 Accountable Care Organization MO N/A 0 0 Heart Hospital of South Dakota LLC 4500 W 69th Street Sioux Falls SD 57108 562143771 Healthcare Services NC N/A 0 0 Surgical Associates Endoscopy Clinic LLC 310 S Pennsylvania Aberdeen SD 57401 460461429 Surgical Associates SD N/A 0 0 Accounts Management Inc 5132 S Cliff Ave Suite 101 Sioux Falls SD 57108 460373021 Collection Agency SD N/A C 0 Alucent Australia Pty Ltd Level 10 30 Collings Street Melbourne VIC 3000 AS Biotech research AS N/A 0 Alucent Biomedical Inc 1325 S Cliff Avenue PO Box 5045 Sioux Falls SD 571175045 471818349 Biotech research SD N/A C 0 Avera Property Insurance Inc 1000 West 4th Street Suite 1 Yankton SD 57078 460463155 Insurance SD N/A C 0 DakotaCare Administrative Services Inc 5300 South Broadband Lane Sioux Falls SD 57108 460424322 Insurance SD N/A C 0 Kore Cares in Home Services LLC 5300 South Broadband Lane Sioux Falls SD 57108 882278902 In-home care services SD N/A S 0 South Dakota State Medical Holding Company Inc 5300 South Broadband Lane Sioux Falls SD 57108 460401087 Insurance SD N/A C 0 Valley Health Services 501 Summit Street Yankton SD 57078 460357149 Rental real estate SD N/A C 0 0 0 1 0 0 0 1 0 0 1 1 1 1 1 1 1 1 1 1 Avera Tyler L 161042 General Ledger Avera Granite Falls L 150964 General Ledger Avera Tyler O 1649469 General Ledger Avera Granite Falls O 2887306 General Ledger Avera Granite Falls Q 317439 General Ledger Avera Granite Falls R 71030 General Ledger Form 990, Schedule R, Part II, Tax Exempt Organizations: Holy Family Hospital Foundation dissolved November 2024. Form 990, Schedule R, Part IV, Corporation or Trust: Valley Health Services dissolved June 2025. Alucent Biomedical, Inc. dissolved May 2025. Alucent Australia Pty Ltd dissolved May 2025.