SCHEDULE R
(Form 990)

Department of the Treasury
Internal Revenue Service
Related Organizations and Unrelated Partnerships
MediumBulletComplete if the organization answered "Yes" on Form 990, Part IV, line 33, 34, 35b, 36, or 37.
MediumBulletAttach to Form 990.
MediumBullet Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047
2019
Open to Public Inspection
Name of the organization
Avera at Home
 
Employer identification number

46-0399291
Part I
Identification of Disregarded Entities. Complete if the organization answered "Yes" on Form 990, Part IV, line 33.
(a)
Name, address, and EIN (if applicable) of disregarded entity


(b)
Primary activity


(c)
Legal domicile (state
or foreign country)

(d)
Total income


(e)
End-of-year assets


(f)
Direct controlling
entity

(1) Avera Home Medical Equipment LLC
1325 S Cliff Ave PO Box 5045
Sioux Falls,SD57117
46-0488198
Medical Services - Home Medical Equipment SD 26,671,034 14,578,119 Avera at Home
 










Part II
Identification of Related Tax-Exempt Organizations. Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related tax-exempt organizations during the tax year.
(a)
Name, address, and EIN of related organization


(b)
Primary activity


(c)
Legal domicile (state
or foreign country)

(d)
Exempt Code section


(e)
Public charity status
(if section 501(c)(3))

(f)
Direct controlling
entity

(g)
Section 512(b)(13) controlled entity?
Yes No
(1)Avera Health
3900 W Avera Drive Suite 300

Sioux Falls,SD57108
46-0422673
Healthcare Services SD 501(c)(3) Line 10 N/A
 
No
(2)Sacred Heart Health Services
501 Summit Street

Yankton,SD57078
46-0225483
Healthcare Services SD 501(c)(3) Line 3 Avera Health
 
 
No
(3)Lewis and Clark Health Education and Service Agency
1000 W 4th Street Suite 9

Yankton,SD57078
46-0337013
Healthcare Education SD 501(c)(3) Line 10 Sacred Heart Health Services
 
 
No
(4)Avera St Anthony's Hospital
300 N 2nd Street

ONeill,NE68763
47-0463911
Healthcare Services NE 501(c)(3) Line 3 Avera Health
 
 
No
(5)Avera Holy Family
826 North 8th Street

Estherville,IA51334
42-0680370
Healthcare Services IA 501(c)(3) Line 3 Avera Health
 
 
No
(6)Avera Holy Family Foundation
826 North 8th Street

Estherville,IA51334
42-1317452
Support Health Related Services IA 501(c)(3) Line 10 Avera Holy Family
 
 
No
(7)St Benedict Health Center
401 West Glynn Drive

Parkston,SD57366
46-0226738
Healthcare Services SD 501(c)(3) Line 3 Avera Health
 
 
No
(8)St Benedict Health Center Foundation
West Glynn Drive PO Box B

Parkston,SD57366
46-0458725
Support Health Related Services SD 501(c)(3) Line 12a, I St Benedict Health Center
 
 
No
(9)Avera McKennan
1325 S Cliff Ave PO Box 5045

Sioux Falls,SD57117
46-0224743
Healthcare Services SD 501(c)(3) Line 3 Avera Health
 
 
No
(10)Avera Queen of Peace Hospital
525 North Foster

Mitchell,SD57301
46-0224604
Healthcare Services SD 501(c)(3) Line 3 Avera Health
 
 
No
(11)Avera St Luke's
305 South State Street

Aberdeen,SD57401
46-0224598
Healthcare Services SD 501(c)(3) Line 3 Avera Health
 
 
No
(12)Avera Marshall
300 S Bruce St

Marshall,MN56258
41-0919153
Healthcare Services MN 501(c)(3) Line 3 Avera Health
 
 
No
(13)Avera Gettysburg
606 East Garfield

Gettysburg,SD57442
46-0234354
Healthcare Services SD 501(c)(3) Line 3 Avera St Mary's
 
 
No
(14)Avera St Mary's
801 East Sioux Avenue

Pierre,SD57501
46-0230199
Healthcare Services SD 501(c)(3) Line 3 Avera Health
 
 
No
(15)Avera Tyler
240 Willow Street

Tyler,MN56178
41-0853163
Healthcare Services MN 501(c)(3) Line 3 Avera Marshall
 
 
No
(16)Avera Health Plans Inc
3900 W Avera Drive Suite 101

Sioux Falls,SD57108
46-0451539
Health Financing and Health Plan Administration SD 501(c)(4)   Avera Health
 
 
No
(17)Avera Granite Falls
345 10th Ave

Granite Falls,MN56241
84-3156881
Healthcare Services MN 501(c)(3) Line 3 Avera Marshall
 
 
No
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50135Y
Schedule R (Form 990) 2019
Schedule R (Form 990) 2019
Page 2
Part III
Identification of Related Organizations Taxable as a Partnership. Complete if the organization answered "Yes" on Form 990, Part IV, line 34, because it had one or more related organizations treated as a partnership during the tax year.
(a)
Name, address, and EIN of
related organization



(b)
Primary activity




(c)
Legal
domicile
(state or foreign
country)


(d)
Direct controlling
entity



(e)
Predominant income(related, unrelated, excluded from tax under sections 512-514)

(f)
Share of total income




(g)
Share of end-of-year
assets



(h)
Disproprtionate allocations?




(i)
Code V-UBI
amount in box 20 of
Schedule K-1
(Form 1065)
(j)
General or
managing
partner?



(k)
Percentage
ownership


Yes No Yes No
(1) Heart Hospital of South Dakota LLC

4500 W 69th Street
Sioux Falls,SD57108
56-2143771
Health care services SD N/A
                 
(2) Avera Home Medical Equipment of Floyd Valley Hospital LLC

714 Lincoln St NE
Lemars,IA51031
82-0582350
medical services - home medical equipment SD Avera at Home
 
related 112,900 188,889   No     No 50.000 %
(3) Avera Home Medical Equipment of Sioux Center LLC

38 19th St SW
Sioux Center,IA51250
75-3203100
medical services - home medical equipment SD Avera at Home
 
related 155,488 213,331   No     No 50.000 %
(4) Q&M Properties LLC

525 North Foster
Mitchell,SD57301
73-1652049
medical clinic building SD N/A
                 
(5) Surgical Associates Endoscopy Clinic LLC

310 S Pennsylvania St
Aberdeen,SD57401
46-0461429
surgical associates SD N/A
                 
(6) Avera Home Medical Equipment of Spencer Hospital LLC

2400 S Minnesota Avenue 102
Sioux Falls,SD57117
80-0619999
medical services - home medical equipment SD Avera at Home
 
related 211,912 242,611   No     No 50.000 %
(7) Brookings Health System - Avera HME LLC

101 22nd Ave Suite 101
Brookings,SD57006
45-3204123
Medical services - home medical equipment SD Avera at Home
 
related 205,031 275,900   No     No 50.000 %
(8) National Rural ACO 4 LLC dba Prairie Hills Care Organization

7509 NW Tiffany Springs Parkway
Kansas City,MO64153
37-1780735
accountable care organization KS N/A
                 
(9) National Rural ACO 5 LLC dba Great Plains Care Organization

7509 NW Tiffany Springs Parkway
Kansas City,MO64153
38-3958290
accountable care organization KS N/A
                 
(10) Caravan Health ACO 41 LLC dba Prairie View Care Organization

7509 NW Tiffany Springs Parkway
Kansas City,MO64153
82-1447782
accountable care organization KS N/A
                 
Part IV
Identification of Related Organizations Taxable as a Corporation or Trust. Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related organizations treated as a corporation or trust during the tax year.
(a)
Name, address, and EIN of
related organization
(b)
Primary activity
(c)
Legal
domicile
(state or foreign
country)
(d)
Direct controlling
entity
(e)
Type of entity
(C corp, S corp,
or trust)
(f)
Share of total income
(g)
Share of end-of-year
assets
(h)
Percentage
ownership
(i)
Section 512(b)(13) controlled entity?
Yes No
(1) Valley Health Services

501 Summit Street
Yankton,SD57078
46-0357149
rental real estate SD N/A
C         No
(2) Accounts Management Inc

5132 S Cliff Ave Ste 101
Sioux Falls,SD57108
46-0373021
collection agency SD N/A
C         No
(3) Avera Property Insurance Inc

1000 West 4th Street Suite 1
Yankton,SD57078
46-0463155
insurance SD N/A
C         No
(4) Alucent Medical Inc

1325 S Cliff Avenue PO Box 5045
Sioux Falls,SD571175045
47-1818349
biotech research SD N/A
C         No
(5) South Dakota State Medical Holding Company Inc

5300 South Broadband Lane
Sioux Falls,SD57108
46-0401087
insurance SD N/A
C         No
(6) DakotaCare Administrative Services Inc

5300 South Broadband Lane
Sioux Falls,SD57108
46-0424322
insurance SD N/A
C         No


Schedule R (Form 990) 2019
Schedule R (Form 990) 2019
Page 3
Part V
Transactions With Related Organizations. Complete if the organization answered "Yes" on Form 990, Part IV, line 34, 35b, or 36.
Note. Complete line 1 if any entity is listed in Parts II, III, or IV of this schedule.
Yes
No
1 During the tax year, did the orgranization engage in any of the following transactions with one or more related organizations listed in Parts II-IV?
a Receipt of (i) interest, (ii) annuities, (iii) royalties, or (iv) rent from a controlled entity .....................
1a
 
No
b Gift, grant, or capital contribution to related organization(s) ............................
1b
 
No
c Gift, grant, or capital contribution from related organization(s) ............................
1c
Yes
 
d Loans or loan guarantees to or for related organization(s) ............................
1d
 
No
e Loans or loan guarantees by related organization(s) ............................
1e
 
No
f Dividends from related organization(s) ............................
1f
 
No
g Sale of assets to related organization(s) ............................
1g
 
No
h Purchase of assets from related organization(s) ............................
1h
 
No
i Exchange of assets with related organization(s) ............................
1i
 
No
j Lease of facilities, equipment, or other assets to related organization(s) .......................
1j
 
No
k Lease of facilities, equipment, or other assets from related organization(s) ......................
1k
Yes
 
l Performance of services or membership or fundraising solicitations for related organization(s) .....................
1l
Yes
 
m Performance of services or membership or fundraising solicitations by related organization(s) .................
1m
Yes
 
n Sharing of facilities, equipment, mailing lists, or other assets with related organization(s) ...................
1n
Yes
 
o Sharing of paid employees with related organization(s) ............................
1o
Yes
 
p Reimbursement paid to related organization(s) for expenses ............................
1p
Yes
 
q Reimbursement paid by related organization(s) for expenses ............................
1q
Yes
 
r Other transfer of cash or property to related organization(s) ............................
1r
Yes
 
s Other transfer of cash or property from related organization(s) ............................
1s
Yes
 
2
If the answer to any of the above is "Yes," see the instructions for information on who must complete this line, including covered relationships and transaction thresholds.
(a)
Name of related organization
(b)
Transaction
type (a-s)
(c)
Amount involved
(d)
Method of determining amount involved





Schedule R (Form 990) 2019
Schedule R (Form 990) 2019
Page 4
Part VI
Unrelated Organizations Taxable as a Partnership. Complete if the organization answered "Yes" on Form 990, Part IV, line 37.
Provide the following information for each entity taxed as a partnership through which the organization conducted more than five percent of its activities (measured by total assets or gross revenue) that was not a related organization. See instructions regarding exclusion for certain investment partnerships.
(a)
Name, address, and EIN of entity
(b)
Primary activity
(c)
Legal domicile
(state or foreign
country)
(d)
Predominant income (related, unrelated, excluded from tax under sections 512-514)

(e)
Are all partners
section
501(c)(3)
organizations?
(f)
Share of total income




(g)
Share of
end-of-year
assets
(h)
Disproprtionate allocations?
(i)
Code V-UBI
amount in box 20
of Schedule K-1
(Form 1065)
(j)
General or
managing
partner?
(k)
Percentage
ownership


Yes No Yes No Yes No






























Schedule R (Form 990) 2019
Schedule R (Form 990) 2019
Page 5
Part VII
Supplemental Information
Provide additional information for responses to questions on Schedule R. (see instructions).
Return Reference Explanation
Schedule R (Form 990) 2019

Additional Data


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