2024-05-14T15:16:18-05:00 2023-06-30 450250958 Eide Bailly LLP 800 Nicollet Mall Ste 1300 Minneapolis MN 554027033 990 2022-07-01 460225483 Sacred Heart Health Services SACR 6056688000 501 Summit St Yankton SD 57078 Julie Lautt CFO Avera Health 6056688000 2024-05-08 1 Julie Lautt XXX-XX-XXXX 1 Kim Hunwardsen CPA P00484560 6122536500 2024-05-08 2 AAL1 IAL1 2022 2023-04-26 12:10:37Z Avera Sacred Heart Hospital Douglas R Ekeren 501 Summit St Yankton SD 57078 148707624 0 0928 X avera.org/locations/sacred-heart/ X 1911 SD Promotion of health 15 13 1263 155 0 0 5615771 1712360 143345590 144214967 3884270 2220031 36073 276288 152881704 148423646 44736 166155 0 0 73231926 75590685 0 0 10780 70007784 68715869 143284446 144472709 9597258 3950937 382193873 399640005 54490946 49584411 327702927 350055594 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 129115916 166155 144233913 Avera Sacred Heart's mission is to provide healthcare services to Yankton, South Dakota residents and residents of the surrounding area. Avera Sacred Heart is a 501(c)(3) organization affiliated with Avera Health. Avera Sacred Heart consists of a 99-bed hospital and a 187-bed nursing home, congregate housing facility and a hospice house in Yankton, SD, a 23-bed critical access hospital and a 47-bed nursing home in Creighton, NE, and 15 physician clinics. The physician clinics include primary care, ob/gyn, pediatrics, orthopedics, general surgery, internal medicine, radiation, radiology, oncology, podiatry, therapy, dialysis, behavioral health, and palliative care. Following is a breakdown of these statistics by facility:Avera Sacred Heart Hospital 2,868 Acute inpatient discharges 486 Newborn patient discharges 71 Swing bed patient discharges 90,308 Outpatient visits 394 Swing-bed patient days 1,116 Newborn patient days 37,584 Clinic visitsAvera Sacred Heart Majestic Bluffs 273 Long term care patient discharges 63,224 Long-term care resident daysAvera Creighton Hospital (CAH) 79 Acute inpatient discharges 52 Swing bed patient discharges 7,814 Outpatient visits 594 Swing-bed patient days 19,604 Clinic visitsAvera Creighton Care Centre 34 Long term care patient discharges 12,755 Long-term care resident daysAvera Sacred Heart 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 $2,444,310.Avera Sacred Heart 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 Sacred Heart 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 Sacred Heart 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. 129115916 1 1 0 0 0 0 0 0 1 1 1 1 0 0 1 1 0 1 0 0 0 0 0 0 0 0 1 1 1 0 1 0 0 0 0 0 1 1 0 0 0 0 0 0 1 1 1 0 0 1 168 0 1 1263 1 0 0 0 0 0 0 0 0 0 0 0 0 X 15 13 1 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 0 1 1 0 X X Jamie A Schaefer 6053223992 3900 W Avera Dr Ste 300 Sioux Falls SD 57108 Douglas Ekeren President/CEO 42.00 7.00 X X 0 704190 46432 Brian Steward Chair 2.00 0.00 X X 0 0 0 Kathy Greeneway Vice Chair 2.00 0.00 X X 0 0 0 Carolyn Becker Board Member 2.00 0.00 X 0 0 0 Bernie Hunhoff Board Member 2.00 0.00 X 0 0 0 Jack Hurley Board Member 2.00 0.00 X 0 0 0 Sr Debra Kolecka Board Member 2.00 6.00 X 0 0 0 Amy Leon Board Member 2.00 0.00 X 0 0 0 Tom Lorang EdD Board Member 2.00 0.00 X 0 0 0 Beth Mikkelsen MD Board Member 2.00 0.00 X 0 0 0 Steve Schindler Board Member 2.00 0.00 X 0 0 0 Steve Schmeichel Board Member 2.00 0.00 X 0 0 0 Sr Roxanne Seifert Board Member 2.00 7.00 X 0 0 0 Richard Strom MD Board Member 2.00 0.00 X 0 0 0 Sr Lucille Welbig Board Member 2.00 5.00 X 0 0 0 Julie Lautt CFO Avera Health;Secretary/Treasurer 0.10 46.30 X 0 1086452 17088 Anthony Erickson VP - Senior Services 40.00 0.00 X 204761 0 36273 Lindsay Flannery VP - Patient Care Services 40.00 0.00 X 211601 0 10864 Derrick Doolittle MD Diagnostic Radiology & Radiology 40.00 0.00 X 733115 0 54311 Steve Gutnik MD FACP Gastroenterology & Internal Medicine 40.00 0.00 X 869935 0 27270 Michael Peterson MD Radiation Oncology & Oncology 40.00 0.00 X 644352 0 39601 Ryan Sieg MD Orthopedics,Surgery& Sports Medicine 40.00 0.00 X 782142 0 46560 Adam Strehle MD Family Medicine/OB 40.00 0.00 X 677569 0 46461 4123475 1790642 324860 91 0 1 0 Avera Health 3900 W Avera Dr Ste 301 Sioux Falls SD 57108 Shared Services 14432570 AMN Healthcare Inc 12400 High Bluff Dr San Diego CA 92130 Staffing Services 2299672 Yankton Medical Clinic PC 1104 W 8th St Yankton SD 57078 Physician Services 1725170 Wilcockson Eye Association PO Box 819 Yankton SD 57078 Medical Services 1152598 Restorix Health Inc 3445 N Causeway Blvd Ste 600 Metairie LA 70002 Professional Services 775341 24 83769 1584985 43606 1712360 Net Patient Service Revenue 621110 139405391 139405391 Pharmacy Revenue 456110 1456886 1456886 Patient and Clinic Revenue 621110 346569 346569 3006121 3006121 144214967 61725 61725 541320 283978 257342 257342 257342 2128863 29443 0 0 2128863 29443 2158306 2158306 A/R Interest Income 900099 18946 18946 18946 148423646 144233913 0 2477373 X 166155 166155 489670 489670 306046 306046 59196993 58537331 659662 2211207 2160021 51186 9403694 9220603 183091 3983075 3849681 133394 22253 22253 7542 7542 29182153 19541868 9640256 29 12447 9720 2727 1527231 1158959 367864 408 514645 465554 49091 3074401 2872019 202382 325316 313579 11737 225374 204274 21100 1553728 438069 1115659 7150782 5500643 1648211 1928 691158 156338 534820 Medical Supplies 22995582 22964502 31080 Equipment Lease/Rental 110940 108169 2771 1322317 1142385 171517 8415 144472709 129115916 15346013 10780 2699257 1509292 19223179 18726513 2562008 2712631 1064659 836106 176879224 121350112 59102374 55529112 288812533 311089730 1075779 1900608 6897639 6827460 756445 508553 382193873 399640005 11211735 9405538 671150 88899 40629381 38970243 104880 56259 1873800 1063472 54490946 49584411 X 315209674 336728564 12493253 13327030 327702927 350055594 382193873 399640005 X 3950937 17147736 1253994 X X 0 1 X 1 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 1 7542 7542 0 Part II-B, Line 1: Sacred Heart Health Services paid dues to organizations which have a portion of the dues attributed to lobbying activities. 0 1 X 807800 8389 14 816175 799040 9465 705 807800 778088 21096 144 799040 747239 31029 180 778088 713075 37964 3800 747239 0.00000 0.82848 0.17152 0 1 1 4355594 4355594 118961194 80693820 38267374 46371301 35451022 10920279 7191135 5205270 1985865 55529112 Avera Pooled Investments 296397083 F Interest in Avera Health Foundation 14692647 F 311089730 Derivative Liability 130658 Intercompany Liabilities 780837 Right of Use Operating Lease Obligations 29636 Security Deposits 85000 Other liabilities 37341 1063472 X Part IV, Line 2b: Resident trust funds are held on behalf of the residents. Part V, Line 4: The Organization's endowment consists of various individual funds established for a variety of purposes. Its endowment represents donor-restricted endowment funds. As required by generally accepted accounting principles, net assets associated with endowment funds are classified and reported based on the existence or absence of donor-imposed restrictions. The endowment fund calculation was changed in current year and all amounts for prior years have been updated to properly reflect the new calculation. 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 0 1 1 611504 611504 0.00420 16536948 11536274 5000674 0.03460 190790 101293 89497 0.00060 17339242 11637567 5701675 0.03940 422022 422022 0.00290 36665 36665 0.00030 1242547 30601 1211946 0.00840 109763 109763 0.00080 1810997 30601 1780396 0.01240 19150239 11668168 7482071 0.05180 18400 18400 0.00010 113837 113837 0.00080 60000 60000 0.00040 3351 3351 0.00000 300 300 0.00000 195888 195888 0.00130 1 5567497 34410418 32082776 2327642 X 1 1 2 1 Avera Sacred Heart Hospital 501 Summit Street Yankton SD 57078 See Part V Section C 10576 X X X 7 provider based clinics 2 Avera Creighton Hospital 1503 Main Street Creighton NE 68729 See Part V Section C 490001 X X X X 1 provider based clinic and 5 RHC's Avera Sacred Heart Hospital 1 0 0 1 X X X X X X X X X 21 1 0 0 1 X See part V Section C X See Part V Section C X 1 21 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 Section C X See Part V Section C X See Part V Section C X X X X X X X 1 X 0 X X X X X 1 X 0 0 Avera Creighton Hospital 2 0 0 1 X X X X X X X X X 21 1 0 1 1 X See Part V Section C X See Part V Section C X 1 21 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 Section C X See Part V Section C X See Part V Section C X X X X X X X 1 X 0 X X X X X 1 X 0 0 Avera Sacred Heart Hospital Part V, Section B, Line 5: Avera Sacred Heart utilized aspects of the Community Health Needs Assessment and Implementation Planning toolkit developed by the South Dakota Department of Health and focus groups conducted by Maximizing Excellence, LLC to conduct the FY2022 Community Health Needs Assessment. The process involved determining the participant's opinions on the community's strengths, weaknesses, resources, and improvements. Careful consideration was taken to ensure that input gathered was representative of the community at large including the medically underserved, low-income or minority populations. Avera Creighton Hospital Part V, Section B, Line 5: Avera Creighton Hospital, in collaboration with the North Central District Health Department (NCDHD), used community stakeholder meetings, a focus group meeting and surveys to determine the community's strengths, weaknesses, resources and improvements. Those providing community input represented the medically underserved, low-income and minority populations as they serve with these populations through their activities. Avera Creighton Hospital Part V, Section B, Line 6b: North Central District Health DepartmentHolt County Economic DevelopmentNorthstarValentine Community SchoolCentral Nebraska Community Action PartnershipProteus, Inc. Services to Empower FarmworkersLegal Aid of NebraskaO'Neill Public Schools Avera Sacred Heart Hospital Part V, Section B, Line 11: Avera Sacred Heart conducted a community health needs assessment during FY2022. Two significant needs were identified and prioritized in the community health needs assessment process: Behavioral health and substance abuse/addiction and workforce and health care capacity.The following actions were identified and prioritized community health needs:BEHAVIORAL HEALTH AND SUBSTANCE ABUSE/ADDICTIONIncrease community resources relating to behavioral health with special focus on substance abuse and addiction issues.*Analyze the feasibility of an inpatient behavioral health unit at Avera Sacred Heart Hospital.*Advocate for and support the Lewis and Clark Behavioral Health Services, Inc. residential chemical dependency program and unit. Avera Sacred Heart worked with Lewis and Clark Behavioral Health Services, Inc. to create space for their new C.O.R.E. Center located in the Avera Sacred Heart Benedictine Center. C.O.R.E. is an acronym for Crisis Outreach Response Engagement. C.OR.E. opened in FY23 with five beds including one pediatric bed. It is designed to provide immediate, short term Crisis Intervention Services to individuals who have mental health and/or substance use problems. Lewis and Clark Behavioral Health Services, Inc. is working toward offering a detox unit.*Advocate for and support the Lewis and Clark Behavioral Health Services, Inc. as they seek to build a new facility. Lewis and Clark Behavioral Health Services, Inc. broke ground on their new campus in FY23 with an estimated completion timeline for FY25.*Actively recruit psychologists and/or psychiatrists with specialties in behavioral health. *Implement the Avera's "Ask the Question: Are you thinking about suicide" campaign. The campaign has been integrated into the care delivery model at Avera Sacred Heart in FY23. *Implement strategies identified through the Communities that Care grant program as appropriate and feasible. Due to the inability to recruit a grant coordinator, Avera Sacred Heart returned the grant dollars for the Communities that Care program.*Implemented SBIRT (Screening, Brief Intervention, and Referral to Treatment), an evidence-based practice used to identify, reduce, and prevent problematic use, abuse, and dependence on alcohol and illicit drugs.*Implement the Edinburgh Scale for depression and suicide screening for OB patients. Avera Sacred Heart implemented the Edinburgh Scale for depression and suicide screening for OB patients in FY23. WORKFORCE AND HEALTH CARE CAPACITYIncrease workforce and health care capacity to adequately prepare Avera Sacred Heart to meet the future needs of the community.*Further develop and implement an Avera Sacred Heart version of Avera Academy that fits the Yankton community. Avera Sacred Heart created the Avera Academy Camp in conjunction with the Yankton School District, Mount Marty University, and Yankton Thrive for high school students with two cohorts (eleven students) who have completed the camp so far.*Further develop and implement the Avera Scholars program with Mount Marty University. Twelve nursing students were selected as Avera Scholars in FY23.*Develop and implement an Avera Nurse Residency Program at Avera Sacred Heart for new college graduates. All eight new nurses who graduated in the Spring of 2022 participated in the new Avera Nurse Residency Program in FY23. To date, all are still with Avera Sacred Heart. The second cohort of new graduate nurses is currently participating in the program. *Develop and implement a Nurse Recruitment Team with the Avera Sacred Heart Endowed Chair of Nursing recipient at Mount Marty University. The Avera Director of Talent Management and the Endowed Chair of Nursing at Mount Marty University have regularly scheduled meetings that began in FY23.*Utilize Build Dakota Scholarships to build a workforce for Avera Sacred Heart in difficult to recruit positions. ASHH was unsucessful in FY23 recruiting students interested in the Build Dakota Scholarships. ASHH had success in previous years with Surgical Tech and Lab Tech students. ASHH will continue to recruit students for this opportunity.*Continue to promote the Avera Student Loan Program benefit and evaluate critical needs for eligibility with the program. Seventy staff members enrolled in the program in FY23. Three hundred seventy-nine job codes were identified as eligible for the program.Many of these activities are continuations of activities the hospital has been conducting related to the prior community health needs assessment.The following health needs were identified but were not selected for focus: Transportation and affordability. Avera Sacred Heart is committed to providing high quality health care services to meet the needs of its service area. Although not the focus, Avera Sacred Heart is actively implementing cost saving initiatives to contain or minimize costs and will continue to advocate for increased transportation availability in the community. Avera Creighton Hospital Part V, Section B, Line 11: Avera Creighton conducted a community health needs assessment during FY2022. The priority areas to be addressed by Avera Creighton include: Behavioral Health and Heart Health.BEHAVIORAL HEALTHFY2023 Update:*Avera Creighton continued the screenings, education, counseling, transportation and other programs implemented under previous health need assessments.*Avera has opened a behavioral health urgent care in Sioux Falls which has helped improve access.*Avera Creighton also utilizes eEmergency for emergent behavioral health assessments in the ED to determine if the patient truly needs to be transferred to a behavioral health center or is able to follow-up closely as an outpatient. *Avera Creighton provided behavioral health education for health care providers and nursing staff through Avera Learning Center as well as regular discussions at medical staff and nursing staff meetings. *Avera Creighton provided behavioral health education for the community at local farm and home shows as well as our health fair. Avera Creighton collaborated with the local school to provide behavioral health education on suicide at a health fair during a basketball game. *Avera Creighton utilized media outlets to increase awareness of Mental Health and Suicide- through Avera's "Ask the Question" campaign that launched last fall.HEART HEALTHFY2023 Update:*Avera Creighton continued screenings and programs implemented under previous health need assessments.*Avera Creighton offered free blood pressure screenings at local farm and home shows as well as our health fair. *Avera Creighton offered a patient education campaign focused on definition and treatment of hypertension at the local farm and home shows as well as the health fair.*Avera Creighton collaborated with Northeast Community College on different classes they are able to offer in our community to increase the number of CPR certified members of the community.Many of these activities are continuations of activities the hospital has been conducting related to the prior community health needs assessment.The following health needs were identified but will not be addressed; however, Avera Creighton Hospital will continue to assess and monitor the need through planning efforts to serve the health and well-being of the service area of the communities.*No after-hours care options for non-emergent conditions outside of Emergency DepartmentAvera Creighton Hospital has limited staffing availability to expand clinic hours in the evening, which leaves the Emergency Department as the only option for after-hours care in the area.*Unable to bring Planet Heart to our community at this time due to needing an expensive interface for our CT scanner to perform the calcium scoring. Will continue to consider in the future. Avera Sacred Heart Hospital 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 Creighton Hospital 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 Sacred Heart Hospital Part V, Section B, Line 16j: A summary of the financial assistance policy is posted in the hospital facility's emergency rooms, waiting rooms, and admissions office and included on the billing statement. In addition, the financial assistance policy is discussed with the patient upon admission to the facility. Avera Creighton Hospital Part V, Section B, Line 16j: A summary of the financial assistance policy is posted in the hospital facility's emergency rooms, waiting rooms, and admissions office and included on the billing statement. In addition, the financial assistance policy is discussed with the patient upon admission to the facility. Avera Sacred Heart Hospital 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 Creighton Hospital 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 Sacred Heart Hospital 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. Avera Creighton Hospital 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 A organization's website The website for Avera Sacred Heart Hospital is:avera.org/locations/sacred-heart/The website for Avera Creighton Hospital is:avera.org/locations/profile/avera-creighton-hospital Part V, Section B, Line 7a, 7b, and 10a: www.avera.org/about/community-health-needs-assessments/#sacredwww.avera.org/about/community-health-needs-assessments/#creighton Part V, Section B, Line 16a, 16b, and 16c: avera.org/patients-visitors/charity-patient-assistance-programs/financial-assistance-forms/ 7 1 - Avera Sister James Care Center 2111 W 11th Street Yankton SD 57078 Skilled nursing facility 2 - Avera Sacred Heart Majestic Bluffs 2111 W 11th Street Yankton SD 57078 Assisted living 3 - Avera Sacred Heart Hospital-Swing Bed 501 Summit Street Yankton SD 57078 Swing Bed 4 - Avera Creighton Care Centre 1603 Main Street Creighton NE 687292999 Long Term Care 5 - Avera Sacred Heart Hospital-Dialysis 501 Summit Street Yankton SD 57078 Dialysis Unit 6 - AMG Gastroenterology 1104 West 8th Street Yankton SD 57078 Gastroenterology clinic 7 - AMG Willcockson Eye Associates 415 W Third Yankton SD 57078 Optical/Eye 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: A combination of costing methodology was used to calculate the amounts reported in the table. A cost accounting system was used to calculate Medicaid and Means-tested Government Program expenses and shortfalls and Subsidized Health Services for our tertiary medical center. A cost to charge ratio derived from Worksheet 2, Ratio of Patient Care Cost-to-Charges was used to calculate charity care at cost for all entities and Medicaid and Means-tested Government Program expenses and shortfalls and Subsidized Health Services for any operations outside of the tertiary medical center. For all other amounts, costs and revenues as reflected by the general ledger system were used. Part II, Community Building Activities: The community building activities include monetary assistance to organizations that focus their efforts on providing furniture for low income families, neighborhood improvement projects in high needs areas, children and youth development programs, local economic development, and job creation and training programs. 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 concession is located in the audited financial statement report on pages 19 and 20. Part III, Line 8: Sacred Heart Health Services 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 program 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 Sacred Heart Hospital includes community members on committees, boards, and advisory groups to allow community reaction and input in the actions we take. We also review all data provided by the health departments regarding disease rates, mortality, morbidity, population changes, etc. The hospital also conducts focus groups, consumer perception studies, and patient satisfaction surveys to identify primary needs of the community and responds with preventative/educational information or activities for the community. 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 Sacred Heart is a 99-bed hospital in Yankton, South Dakota. Avera Sacred Heart primarily serves the city and county of Yankton and the counties of Bon Homme, Charles Mix, Hutchinson and Clay in South Dakota and counties of Knox and Cedar in Nebraska. The majority of discharges are from Yankton County. According to the U.S. Census Bureau Quick Facts 2021 data, the estimated population of Yankton County as of July 1, 2021 is 23,297 and is predominately white at 91.6%. It is estimated that 20.1% of the population is 65 years and over. The median household income is $61,878 with a 10.4% poverty rate. Uninsured individuals under age 65 is estimated at 12.6%. Part VI, Line 5: The Hospital board is comprised of individuals who represent the interests of the community served by the organization. The Hospital offers staff privileges to all qualified physicians in the community. Selected services such as Radiation Oncology and Swing-bed Services would not be available in our service area unless provided by the organization. The Hospital serves all individuals regardless of their ability to pay, providing 24 hours a day emergency service. The facility participates in the education of medical students from The University of South Dakota through their Yankton location. The Hospital also offers a 2-year Radiology Technologist program that graduates approximately 6 students per year. Sacred Heart Hospital also provides clinical education for Mount Marty University students. The Hospital is also proud of the fact that 128 individuals chose to volunteer at the hospital facility in Yankton during fiscal year 2023. 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 benefits needs. In keeping with Catholic Health 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. 1 Mount Marty University 1105 W 8th Street Yankton SD 57078 460283336 501(c)(3) 58675 0 Fieldhouse, Tobacco Grant, Palliative Care Grant South Dakota State University Morrill Hall 323 Box 2201 Brookings SD 57007 460273801 501(c)(3) 104119 0 Palliative Care Grant 2 0 Part I, Line 2: The Organization provides grants/contributions to other organizations which are tax-exempt under IRC Section 501(c)(3) and governmental divisions that benefit the community and region through programs and activities. 0 0 0 0 0 0 0 0 0 Julie Lautt CFO Avera Health;Secretary/Treasurer 0 1075517 0 460 0 10475 0 15250 0 1838 0 1103540 0 0 Steve Gutnik MD FACP Gastroenterology & Internal Medicine 823926 0 15000 0 31009 0 15250 0 12020 0 897205 0 0 0 Ryan Sieg MD Orthopedics,Surgery& Sports Medicine 692801 0 16000 0 73341 0 15250 0 31310 0 828702 0 0 0 Derrick Doolittle MD Diagnostic Radiology & Radiology 504502 0 205525 0 23088 0 15250 0 39061 0 787426 0 0 0 Douglas Ekeren President/CEO 0 686463 0 725 0 17002 0 15250 0 31182 0 750622 0 0 Adam Strehle MD Family Medicine/OB 344306 0 300946 0 32317 0 15250 0 31211 0 724030 0 0 0 Michael Peterson MD Radiation Oncology & Oncology 620149 0 15000 0 9203 0 15250 0 24351 0 683953 0 0 0 Anthony Erickson VP - Senior Services 202398 0 440 0 1923 0 9766 0 26507 0 241034 0 0 0 Lindsay Flannery VP - Patient Care Services 211154 0 0 0 447 0 10558 0 306 0 222465 0 0 0 Schedule J, Part I Line 3: The President/CEO and CFO-Avera Health are compensated by Avera Health. Avera Sacred Heart relied on the related organization for determining the compensation for the President/CEO and CFO-Avera Health using the methods described in Part I, Line 3. Lawrence Leon Spouse of board member 306046 Employee compensation and benefits 0 Form 990, Part VI, Section A, line 2 Julie Lautt, Sr. Debra Kolecka, Sr. Roxanne Seifert and Douglas Ekeren 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 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 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 board members. 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 CEO-Avera Health was compensated by Avera Health System. Annually the Compensation Committee of Avera Health, which is comprised of six (6) System Members appointed by the Religious Orders, 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. Depending on the individuals's role with the organization, some officers and key employees are compensated by Avera Sacred Heart. 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 8,270,005. Management and general expenses 730,775. Fundraising expenses 0. Total expenses 9,000,780. Medical Professional Fees: Program service expenses 3,886,265. Management and general expenses 590,672. Fundraising expenses 0. Total expenses 4,476,937. Repairs & Maintenance: Program service expenses 3,283,216. Management and general expenses 137,968. Fundraising expenses 29. Total expenses 3,421,213. Centralized Services: Program service expenses 4,102,382. Management and general expenses 8,180,841. Fundraising expenses 0. Total expenses 12,283,223. Form 990, Part XI, line 9: Change in Interest in Avera Foundation 1,156,302. Change in Fair Value of Interest Rate Swap 97,692. 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 Health, which includes Sacred Heart Health Services. Form 990, Part VI, Line 16: There is no written policy or procedure. In the event of any such proposed transaction, the board or a committee with delegated authority reviews all materials, valuations and operational aspects for any proposed transaction. Such transaction would be evaluated in accordance with the exempt status of the organization and its applicable purposes. Any transaction also would be approved by the board and the member. Form 990, Part X, Line 20: The issue price includes the filing organization's share of the entire bond issue, which was issued to Avera Health on behalf of the Avera Obligated Group. The Avera Obligated Group consists of Avera Health, Avera McKennan, Avera St. Luke's, Avera Queen of Peace, Avera Marshall, Avera St. Mary's, Avera St. Anthony's, Avera St. Benedict, Avera Holy Family, Avera Tyler, Avera Granite Falls, Avera Gettysburg, Avera at Home, and Sacred Heart Health Services. In accordance with IRS instructions, information related to the tax exempt bond reporting is being reported on Avera Health's tax return (EIN 46-0422673.) 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 plans admin SD 501(c)(4) 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 Granite Falls 345 10th Ave Granite Falls MN 56241 843156881 Healthcare services MN 501(c)(3) Line 3 Avera Marshall 0 Avera Tyler 240 Willow Street Tyler MN 56178 410853163 Healthcare services MN 501(c)(3) Line 3 Avera Marshall 0 Avera Queen of Peace Hospital 525 N Foster Street 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 Gettysburg SD 57442 460234354 Healthcare services SD 501(c)(3) Line 3 Avera St Mary's 0 Avera Holy Family 826 North 8th Street Estherville IA 51334 420680370 Healthcare services IA 501(c)(3) Line 3 Avera Health 0 Holy Family Hospital Foundation 826 North 8th Street Estherville IA 51334 421317452 Support health related services IA 501(c)(3) Line 10 Avera Holy Family 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 St Benedict Health Center Foundation West Glynn Drive PO Box B Parkston SD 57366 460458725 Support health related services SD 501(c)(3) Line 12a, I St Benedict Health Center 0 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 0 0 Avera Home Medical Equipment of Lakes Regional Healthcare LLC 2301 Hwy 71 South Ste D Spirit Lake IA 51360 862949748 Medical services - home medical equipment IA N/A 0 0 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 0 0 Avera Home Medical Equipment of Spencer Hospital LLC 2400 S MN Ave 102 Sioux Falls SD 57117 800619999 Medical services - home medical equipment SD N/A 0 0 Brookings Health System - Avera HME LLC 101 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 7509 NW Tiffany Springs Parkway Ste Kansas City MO 64153 611843657 Accountable care organization MO N/A 0 0 Caravan Health ACO 41 LLC dba Prairie View Care Organization 7509 NW Tiffany Springs Parkway Kansas City MO 64153 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 SD N/A 0 0 Surgical Associates Endoscopy Clinic LLC 310 S Pennsylvania St 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 882778902 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 Inc 501 Summit Street Yankton SD 57078 460357149 Rental real estate SD Sacred Heart Health Services C -116634 1049059 1.00000 1 0 0 1 0 0 0 0 0 0 0 0 1 1 0 0 1 1 1 0 Valley Health Services Inc Q 110575 FMV Form 990, Schedule R, Part II St. Benedict Health Center Foundation dissolved as of December 31, 2022.