1. Avera Marshall Update Presented to the Marshall City Council July 10, 2012 Mary Maertens, President & CEO

2. Background One of five regional Avera facilities 25-bed critical access hospital 76-bed long-term care facility Emergency care center – level 3 trauma designation Behavioral Health Center opened in July 2007 Outpatient services center Avera Medical Group clinics Management agreement with Avera in 2004 and renamed Avera Marshall Regional Medical Center Became an Avera sponsored facility in Nov. 2009

3. Physicians Office Building

4. Ground breaking in August 2011 Project continues on time and on budget Local contractors Substantial completion expected in September Phased move-in to new construction followed by remodeling of existing clinic spaces Fully completed in December 2012

5. Avera Marshall Physicians Office Building

6. Clinic space for Avera Medical Group providers : Ophthalmology & Optometry Obstetrics/Gynecology Internal Medicine General Surgery Orthopedics Pediatrics Family Medicine

7. 22,500 square feet of new construction 5,220 square feet of remodeled space within the existing clinic structure 40 exam rooms, including 4 procedure rooms

8. Physicians Office Building Features Decentralized check in and waiting areas On-stage/off-stage layout, with staff core Clinic based lab and imaging services Convenient drive-up, drop-off area Extensive measures to protect patient privacy – exam room construction, white noise, etc.

9. Strength of Avera Purpose of the initial partnership was to elevate Avera Marshall to a regional medical center: Operational support System branding Physician recruitment and retention activities Service/product expansion Investment in advanced technology Excellence in quality and customer service Building relationships with business entities & health care providers

10. Avera Marshall Growth 1.Recruitment of health care providers 2.Service expansion 3.Regional footprint 4.Financial milestones 5.Technology

11. Recent… Family Medicine: – Melissa Scotting, CNP – Theresa Bly, CNP Psychiatry: – William Del Monte, II, MD Optometry: – Melissa Younger, OD Recruitment of Providers

12. Future… Family Medicine: – Amy Nicolas, CNP (8/2012) – Jane Hartman, MD (10/2012) General Surgery: – Traci Kruse, MD (9/1/2012) Hospital Medicine: – Justin Hartman, MD (8/1/2012) Additional recruitment in pediatrics, internal medicine, psychiatry, family practice, orthopedics

13. Service Expansion Recent: Palliative Care Lasik – laser vision correction New Surgery Center Medical Home Future/under consideration: Emergency Department expansion Cancer services

14. Expanding our Footprint Bringing specialty care to the region… Recent additions: Granite Falls – Dr. Louwagie, Ophthalmology outreach Slayton – Dr. Reber, Ob/Gyn outreach Dr. Buntrock, Ophthalmology outreach Tyler – Dr. Buntrock, Ophthalmology outreach Marshall – Dr Affolter practice acquisition Future… Redwood Falls

15. Technology Recent: AveraChart electronic medical record Avera eCARE complement of services Surgery Center DexaScan Future: Stereotactic breast biopsy Continued AveraChart/electronic medical record advances

16. Financial Milestones Nearing $100 million gross revenue $12 million net revenue growth Foundation surpassed $1 million mark Auxiliary has donated over $2.5 million

17. Health Care Reform Supreme Court Upholds Affordable Care Act -- Avera recognizes that the law is not perfect, but it does provide insurance coverage for everyone. Insurance coverage for everyone makes health care more accessible for those people who can least afford it. Avera has been working to position our organization to be ready for full implementation of this law. We can now move forward with our plans. Avera long has been committed to providing care for everyone. The United States Supreme Court affirmed the importance of health care for everyone. The individual mandate was upheld. Medicaid expansion TBD

18. Health Care Reform in Minnesota Task force appointed by Gov. Dayton to develop strategies to improve access to health care, lower costs and improve health of Minnesotans. Current strategies address: Health insurance exchange Affordability Quality and coordination Prevention/wellness Long-term care Health care workforce

19. Health Reform in Minnesota: Health Insurance Exchange Marketplace for consumers to compare, choose and buy health insurance Compare based on cost, quality and consumer satisfaction States have until January 2013 to create health insurance exchange or federal government will establish one Available to consumers in 2014

20. State Legislative Update-- Minnesota Health & Human Services Budget Restored hospitals decision-making authority regarding community benefit activity Improvements to Provider Peer Grouping law Working to restore cuts to Emergency Medical Assistance program – funding restored for dialysis and cancer treatment for individuals eligible for EMA Legislation creating new felony charge under Minnesotas Vulnerable Adult law