2022-05-16T15:19:03-05:00 2021-06-30 450250958 Eide Bailly LLP 800 Nicollet Mall Ste 1300 Minneapolis MN 554027033 990 2020-07-01 460225483 Sacred Heart Health Services SACR 6056688000 501 Summit Yankton SD 57078 Julie Lautt CFO Avera Health 6056688000 2022-05-12 1 Julie Lautt 999009999 Kim Hunwardsen CPA P00484560 6122536500 2022-05-12 2 AAL1 IAL1 2020 2022-09-23 18:48:47Z Avera Sacred Heart Hospital Douglas R Ekeren 501 Summit Yankton SD 57078 161026415 0 0928 X See Schedule O X 1911 SD Promotion of Health 16 13 1320 68 0 0 9026027 9923500 128531250 138048330 5156355 12368103 -168215 -196562 142545417 160143371 40429 193218 0 0 67056201 68960030 0 0 13474 64454670 69352286 131551300 138505534 10994117 21637837 377780672 414934041 80309286 58930166 297471386 356003875 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 116195420 193218 138148932 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 14 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 Hospital2,788 Acute inpatient discharges541 Newborn patient discharges90 Swing bed patient discharges101,261 Outpatient visits525 Swing-bed patient days1,384 Newborn patient days27,316 Clinic visitsAvera Sacred Heart Majestic Bluffs294 Long term care patient discharges59,398 Long-term care resident daysAvera Creighton Hospital (CAH)122 Acute inpatient discharges85 Swing bed patient discharges16,285 Outpatient visits887 Swing-bed patient days16,280 Clinic visitsAvera Creighton Care Centre14 Long term care patient discharges15,182 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 $2,122,013.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.During the COVID pandemic over the last two years, Avera Health and its affiliated entities have stewarded significant funding toward community benefit, from our own resources and from state and federal assistance and relief funds. When the first cases were identified in 2020, we created a 24/7 hotline people could call to inquire about testing, treatment, and later vaccination. This hotline minimized the burden of clinics and helped protect patients and the public by keeping patients from presenting to healthcare facilities in person. Along with the hotline, Avera launched an innovative and specialized program for caring for COVID patients at home, including daily checkins, virtual visits (if needed) and at-home oxygen therapy. Throughout the pandemic this program has supported patients and kept hospitals from becoming overwhelmed.Additionally we launched public awareness campaigns for masking and vaccination that included earned media, paid advertising and digital presence. We set up testing sites and events, including a mass testing event for workers at the local protein plant. The state delegated vaccination efforts to South Dakota's health systems, and our state was recognized nationally for our "shots in arms" efficiency. Avera led efforts to prioritize those at highest risk, including not only elderly and infirm but homeless, congregate living residents and proteinplant workers which included a high percentage of immigrants. We participated in national research for COVID therapies including convalescent plasma, monoclonal antibodies and antiviral medications. We worked with local and state officials to inform the public at regular press conferences and expanded bed capacity by reallocating resources across all hospitals in our system. Avera partnered with other health facilities and systems to ensure capacity for the sickest patients, and those in need of ICU care and ventilators. Avera also launched efforts to support and retain health care workforce, including such things as paying health insurance premiums, providing support payments, $2 across-the-board pay increases, increased on-call pay and shift differentials, and more. 116195420 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 0 0 0 1 130 0 1 1320 1 0 0 0 0 0 0 0 0 0 0 0 0 X 16 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 41.50 1.00 X X 0 626756 40677 Ryan Loecker Chair 2.00 0.00 X X 0 0 0 Brian Steward Vice Chair 2.00 0.00 X X 0 0 0 Jack Hurley Board Member 2.00 0.00 X 0 0 0 Sr Lucille Welbig PBVM Board Member 2.00 5.00 X 0 0 0 Richard Strom MD Board Member 2.00 0.00 X 0 0 0 Carolyn Becker Board Member 2.00 0.00 X 0 0 0 Kathy Greeneway Board Member 2.00 0.00 X 0 0 0 Steve Schindler Board Member 2.00 0.00 X 0 0 0 Amy M Leon Board Member 2.00 0.00 X 0 0 0 Bernie Hunhoff Board Member 2.00 0.00 X 0 0 0 Sr Debra Kolecka OSB Board Member 2.00 6.00 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 Scott Hiltunen MD Board Member/Chief of Staff 40.00 0.00 X 500458 0 46124 Sr Roxanne Seifert Board Member 2.00 3.00 X 0 0 0 Julie Lautt CFO Avera Health;Sec/Treas 0.10 41.30 X 0 903545 36378 Anthony Erickson Executive Director Senior Services 40.00 0.00 X 197329 0 47857 Lindsay Flannery VP Patient Care Services 40.00 1.00 X 204763 0 10513 Steve Gutnik MD FACP Gastroenterology/Internal Medicine 40.00 0.00 X 899626 0 27351 Derrick Doolittle Diagnostic Radiology 40.00 0.00 X 587290 0 52435 Michael Peterson MD Radiation Oncology 40.00 0.00 X 674835 0 37541 Matthew Winkelbauer MD Family Medicine/OB 40.00 1.00 X 558252 0 45524 Courtney Elizabeth Merkwan Emergency Medicine 40.00 0.00 X 601968 0 46124 Jim Breckenridge Former CFO Avera Health;Sec/Treas 0.00 0.00 X 0 329248 15667 Jamie SchaeferFormer Sec/Treas & VP Finance 0.00 40.00 X 0 272673 47623 4224521 2132222 453814 93 1 1 0 Avera Health 3900 W Avera Dr Ste 301 Sioux Falls SD 57108 Shared Services 15180728 Avera McKennan 1325 S Cliff Ave Sioux Falls SD 57105 Physician Services 3196333 Yankton Medical Clinic PC 1104 W 8th St Yankton SD 57078 Physician Services 1663528 Health Carousel 3805 Edwards Rd 700 Cincinnati OH 45209 Physician Services 645371 Yankton Anesthesiology PC 1000 W 4th St Ste 13 Yankton SD 57078 Anesthesiologists 602082 19 224218 9679241 20041 13684 9923500 Net Patient Service Revenue 622110 133763139 133763139 Pharmacy Revenue 900099 743673 743673 3541518 3541518 138048330 585880 883044 -297164 -297164 -297164 12331173 36930 0 0 12331173 36930 12368103 12368103 A/R Interest Income 900099 100602 100602 100602 160143371 138148932 0 12070939 X 193218 193218 918300 461585 456715 53844658 52466326 1378332 2016798 1927104 89694 8572303 8322360 249943 3607971 3479894 128077 28846 28846 28622565 13734228 14888337 6502 6225 277 1458035 860385 597430 220 921533 415950 505583 2785371 2310209 475162 192475 190823 1652 180768 140025 40743 1471779 305992 1165787 7639407 5664156 1973323 1928 411244 140270 270974 Medical Supplies 24026421 23986315 40106 Equipment Lease/Rental 107550 103739 3811 1499790 1486616 1848 11326 138505534 116195420 22296640 13474 235336 7079028 17677389 16741242 2598528 2473654 703910 864140 179723921 117316085 68810963 62407836 276840312 312527266 977202 958856 6993128 6925628 2943904 4956391 377780672 414934041 10987602 10836089 5410465 1441064 43825570 42247031 39123 98953 20046526 4307029 80309286 58930166 X 285160140 341778496 12311246 14225379 297471386 356003875 377780672 414934041 X 21637837 34421283 2473369 X X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 1 X 1055534 18096 178943 1044 1251529 1157988 31030 -10503 122981 1055534 1282484 38285 41728 204509 1157988 1071080 28881 188014 5491 1282484 1071080 38729 -24812 13917 1071080 0.00000 0.52945 0.47055 0 1 1 4515594 4515594 124652821 79960683 44692138 43219511 32393624 10825887 7335995 4961778 2374217 62407836 Avera Pooled Investments 297204439 F Interest in Avera Health Foundation 15322827 F 312527266 Estimated third-party payor settlements 979398 Derivative Liability 433557 Deferred Payroll Taxes 2380831 Right of Use Operating Lease Obligations 513243 4307029 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. 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 1 X 1 1 0 0 538693 538693 0.00390 15903438 10820495 5082943 0.03670 165480 80332 85148 0.00060 16607611 10900827 5706784 0.04120 378795 378795 0.00270 44107 44107 0.00030 360470 54327 306143 0.00220 187067 187067 0.00140 970439 54327 916112 0.00660 17578050 10955154 6622896 0.04780 217488 217488 0.00160 62774 62774 0.00050 1942 1942 0.00000 1720 1720 0.00000 430 430 0.00000 860 860 0.00000 285214 285214 0.00210 1 5380670 33917872 32322754 1595118 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 18 1 0 0 1 X See part V Section C X See Part V Section C X 1 18 1 See Part V Section C 0 1 X 150.000000000000 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 18 1 1 1 1 X See Part V Section C X See Part V Section C X 1 18 1 See Part V Section C 0 1 X 150.000000000000 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 Improvement Planning toolkit developed by the South Dakota Department of Health, focus groups conducted by Maximizing Excellence, LLC and an online survey. 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, 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 6a: Antelope Memorial HospitalAvera St. Anthony's HospitalBrown County HospitalCHI PlainviewOsmond General Hospital Avera Creighton Hospital Part V, Section B, Line 6b: North Central District Health Department Region 4 Behavioral Health SystemEducational Service Unit #8, School Nurse University of Nebraska-Lincoln extensionRural Region One Medical Response System Avera Sacred Heart Hospital Part V, Section B, Line 11: The community health needs assessment was completed in 2018. The following community health priority areas were identified and actions will be taken by the hospital. Many of the priority areas identified in the community health needs assessment are in maintenance mode as the focus of community health needs was the Covid pandemic in fiscal year 2021.CHRONIC DISEASE & NUTRITION-Enhance the nutrition wellness section of the Avera Sports Coach Rozy strength and conditioning programs.-Provide annual education and/or cooking demonstration on healthy eating as a component for wellness for those who experience chronic diseases.FY2021: Continue to provide education on healthy eating as a component for wellness via social media for those who experience chronic diseases. This has been done on both the Avera Health and Avera Sacred Heart social media sites. -Enhance the relationship between Avera Sacred Heart Hospital and the local grocery store Hy-Vee's dietician.-Enhance the nutrition education provided to the Lewis and Clark Behavioral Health Services, Inc. residential chemical dependency program and unit located on third floor of the Avera Sacred Heart Hospital Benedictine Center.FY2021: Continue to enhance and implement nutrition education.-Provide an annual meal preparation and planning program.FY2021: Meal preparation and planning program continues to be offered on the Avera Health social media sites. This information has been shared on the Avera Sacred Heart social media site as well. BEHAVIORAL HEALTH & SUBSTANCE ABUSE-Analyze the feasibility of an inpatient behavior health unit at Avera Sacred Heart Hospital. Advocate for and support the Lewis and Clark Behavioral Health Services, Inc. residential chemical dependency program and the unit located on the third floor of the Avera Sacred Heart Hospital Benedictine Center.FY2021: Continue to analyze and advocate for behavioral health programs and services.-Actively recruit psychologists and/or certified nurse practitioners with specialties in behavioral health for the Avera Medical Group Behavioral Health Clinic.FY2021: Recruitment in progress.-Provide educational and informational opportunities for the community.FY2021: Continue to provide posts regarding community educational and informational opportunities on Avera Health and Avera Sacred Heart's social media sites .-Implement the Avera Medical Group's opioid reduction strategies in the Avera Medical Group clinics in the Avera Sacred Heart Region.FY2021: Continue to maintain the program as implemented.-Avera Medical Group Pain Management will implement quarterly behavioral health evaluations for all patients on a pain contract.FY2021: Continue to maintain the program as implemented.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/priorities will not be addressed due to either a relative low priority, resource constraints or, because other facilities or educational entities are addressing the issues:-Health Literacy-Transportation-Language Services-Access to Specialists-Healthcare Costs Avera Creighton Hospital Part V, Section B, Line 11: The community health needs assessment was completed in 2018. The following community health priority areas were identified and actions will be taken by the hospital.BEHAVIORAL HEALTH- Improve access to behavioral health providers- Behavioral health education for health care providers and nursing staff- Behavioral health education in collaboration with the area school system on suicide prevention- Behavioral health education for the communityFY2021: - Clinic providers continue to use the Avera Behavioral Health Outpatient Triage program. This allows them to access a behavioral health counselor virtually to visit with the patient on the day they presented to the clinic rather than waiting to schedule an appointment. - Revisions were made to the required screening for all emergency room patients, all admissions, and all clinic patients to include the PHQ-9 screening. The PHQ-9 screening tool helps evaluate a patient's overall mental health with a focus on depression. The 9 questions generate a score, symptom severity and action needed based on the score. If this screen is positive, it will generate PSS-3 screen for suicide risk to help the provider determine next steps in treatment. - In June 2021 a project to implement eSANE started. A grant provided equipment and training to providers and nursing staff to care for a patient that had been sexually assaulted. Weekly implementation calls were held and included a local organization, Bright Horizons, to be notified and fill the role of the patient advocate during the exam and the follow up counseling and advocacy needed if the patient chooses to press charges. The RN at this hospital will connect virtually to a certified SANE nurse in Sioux Falls to help with the assessment and collection of evidence. This program went live September 2021 but there have not been any sexual assault patients since implementation. - The hospital completed the Age Friendly designation in 2021. This designation involves reliably providing a set of 4 evidence-based elements to all older adults known as the 4 M's: What Matters, Medication, Mentation and Mobility. During the work on Mentation, a Delirium guide for patients, family members and caregivers was developed. The NuDESC Delirium Screen was added as a required screening in the EMR for inpatients and is completed every 12 hours. Providers and nursing staff were trained in symptoms of delirium, the use of the screening tool and how to help patients that are experiencing delirium. These Delirium guides are given to patients and family on admission as appropriate. HYPERTENSION- Explore options for increasing the number and location of blood pressure screenings in the community- Patient education campaign focused on definition and treatment of hypertensionFY2021: In the spring of 2020 the Avera Medical Group added a Patient Coordinated Care nurse position. This nurse focuses on chronic health conditions for any patient of AMG clinics in Creighton, Verdigre, Niobrara, Crofton, Hartington and Pierce. This nurse provides education to the patients on hypertension, medications and other ways to reduce blood pressure. This program provided services to 28 patients in our service area in 2021.DIABETES- Continued evaluation of the current diabetic education program- Market the current diabetic program through collaboration with marketing to distribute information in multiple ways- Provide an educational program on diabetes recognition and treatmentFY2021: In the spring of 2020 the Avera Medical Group added a Patient Coordinated Care nurse position. This nurse focuses on chronic health conditions for any patient of AMG clinics in Creighton, Verdigre, Niobrara, Crofton, Hartington and Pierce. This nurse provides education to diabetic patients on diet, exercise, monitoring blood sugar and diabetic medications. This program provided services to 28 patients in our service area in 2021 but there is no data on how many of these patients had diabetes.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/priorities will not be addressed due to either a relative low priority, resource constraints or, because other facilities or educational entities are addressing the issues:-Lack of assisted living facility in Creighton-Limited restaurants in the service area-Limited senior center activities 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/ Part V, Section B, Line 16a, 16b, and 16c: https://www.avera.org/patients-visitors/charity-patient-assistance-programs/financial-assistance-forms/ 6 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 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 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 17 and 18. 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 2019 data, the estimated population of Yankton County as of July 1, 2019 is 22,814 and is predominately white at 91.8%. It is estimated that 19.5% of the population is 65 years and over. The median household income is $58,342 with a 10.1% poverty rate. Uninsured individuals under age 65 is estimated at 10.2%. 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, Dialysis and Swingbed 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 services. The facility participates in the education of medical students from The University of South Dakota Medical School through their Yankton location. In addition, the Hospital is the site for the rural experience portion of the Surgical Residency program of the University of South Dakota Medical School and a clinical site for the University of South Dakota nursing program. The Hospital 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 proud of the fact that 68 individuals chose to volunteer at the facility during fiscal year 2021. 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) 56090 Fieldhouse/HRSA Palliative Care Grant Sub Award Presentation College 1500 N Main Street Aberdeen SD 57401 460280847 501(c)(3) 11956 HRSA Palliative Care Grant Sub Award South Dakota State University PO Box 2201 Brookings SD 57007 466000364 501(c)(3) 90357 HRSA Palliative Care Grant Sub Award 3 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;Sec/Treas 0 842009 0 55127 0 6409 0 14250 0 22128 0 939923 0 0 Steve Gutnik MD FACP Gastroenterology/Internal Medicine 774021 0 94486 0 31119 0 14250 0 13101 0 926977 0 0 0 Michael Peterson MD Radiation Oncology 628430 0 37350 0 9055 0 14250 0 23291 0 712376 0 0 0 Douglas Ekeren President/CEO 0 587258 0 28842 0 10656 0 14250 0 26426 0 667432 0 0 Courtney Elizabeth Merkwan Emergency Medicine 484289 0 87975 0 29704 0 14250 0 31874 0 648092 0 0 0 Derrick Doolittle Diagnostic Radiology 467343 0 81495 0 38452 0 14250 0 38185 0 639725 0 0 0 Matthew Winkelbauer MD Family Medicine/OB 534361 0 21536 0 2355 0 14250 0 31275 0 603777 0 0 0 Scott Hiltunen MD Board Member/Chief of Staff 293986 0 203729 0 2743 0 14250 0 31874 0 546582 0 0 0 Jim Breckenridge Former CFO Avera Health;Sec/Treas 0 299918 0 0 0 29330 0 7704 0 7964 0 344916 0 0 Jamie SchaeferFormer Sec/Treas & VP Finance 0 270465 0 500 0 1708 0 14008 0 33615 0 320296 0 0 Anthony Erickson Executive Director Senior Services 193885 0 400 0 3044 0 10361 0 37496 0 245186 0 0 0 Lindsay Flannery VP Patient Care Services 203644 0 0 0 1119 0 10182 0 330 0 215275 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 378797 Employee compensation and benefits 0 Form 990, Item J The organization's website is: avera.org/locations/sacred-heart/ Form 990, Part VI, Section A, line 2 Sr. Debra Kolecka, Jim Breckenridge, Julie Lautt, Jamie Schaefer 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 reviewed by the Avera Health VP of Financial Reporting, Tax Manager, Facility CEO and Finance Committee (if applicable). After initial review the Form 990 is made available to the Board and other Operation Finance Leaders. 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 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 8,508,220. Management and general expenses 834,363. Fundraising expenses 0. Total expenses 9,342,583. Repairs and Maintenance: Program service expenses 3,030,321. Management and general expenses 197,887. Fundraising expenses 0. Total expenses 3,228,208. Centralized Services: Program service expenses 0. Management and general expenses 13,212,726. Fundraising expenses 0. Total expenses 13,212,726. Medical Professional Fees: Program service expenses 2,195,687. Management and general expenses 643,361. Fundraising expenses 0. Total expenses 2,839,048. Form 990, Part XI, line 9: Change in fair value of interest rate swap 144,177. Change in Net Assets held by Avera Health Foundation 2,329,192. 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 at Home 5116 S Solberg Ave Sioux Falls SD 57108 460399291 Home Services SD 501(c)(3) Line 10 Avera Health 0 Lewis and Clark Health Education and Service Agency 1000 W 4th Street Suite 9 Yankton SD 57078 460337013 Healthcare education SD 501(c)(3) Line 10 Sacred Heart Health Services 1 Avera St Anthony's Hospital 300 N 2nd Street ONeill NE 68763 470463911 Healthcare services NE 501(c)(3) Line 3 Avera Health 0 Avera Holy Family 826 North 8th Street Estherville IA 51334 420680370 Healthcare services IA 501(c)(3) Line 3 Avera Health 0 Avera Holy Family Foundation 826 North 8th Street Estherville IA 51334 421317452 Support health related services IA 501(c)(3) Line 10 Avera Holy Family 0 Avera Marshall 300 S Bruce St Marshall MN 56258 410919153 Healthcare services MN 501(c)(3) Line 3 Avera Health 0 St Benedict Health Center 401 West Glynn Drive Parkston SD 57366 460226738 Healthcare services SD 501(c)(3) Line 3 Avera Health 0 St Benedict Health Center Foundation 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 McKennan 1325 S Cliff Ave PO Box 5045 Sioux Falls SD 57117 460224743 Healthcare services SD 501(c)(3) Line 3 Avera Health 0 Avera Queen of Peace Hospital 525 N Foster Street Mitchell SD 57301 460224604 Healthcare services SD 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 Gettysburg 606 East Garfield Gettysburg SD 57442 460234354 Healthcare services SD 501(c)(3) Line 3 Avera St Mary's 0 Avera St Mary's 801 East Sioux Avenue Pierre SD 57501 460230199 Healthcare services SD 501(c)(3) Line 3 Avera Health 0 Avera Tyler 240 Willow Street Tyler MN 56178 410853163 Healthcare services MN 501(c)(3) Line 3 Avera Marshall 0 Avera Health Plans Inc 3900 West Avera Drive Suite 101 Sioux Falls SD 57108 460451539 Health financing and health plans 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 0 Surgical Associates Endoscopy Clinic LLC 310 S Pennsylvania St Aberdeen SD 57401 460461429 Surgical associates SD N/A 0 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 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 Q&M Properties 525 North Foster Mitchell SD 57301 731652049 Medical clinic building SD 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 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 National Rural ACO 4 LLC dba Prairie Hills Care Organization 7509 NW Tiffany Springs Parkway Kansas City MO 64153 371780735 Accountable care organization KS N/A 0 0 National Rural ACO 5 LLC dba Great Plains Care Organization 7509 NW Tiffany Springs Parkway Kansas City MO 64153 383958290 Accountable care organization KS 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 KS N/A 0 0 Valley Health Services Inc 501 Summit Street Yankton SD 57078 460357149 Rental real estate SD Sacred Heart Health Services C -47053 1419106 1.00000 1 Accounts Management Inc 5132 S Cliff Ave Suite 101 Sioux Falls SD 57108 460373021 Collection agency 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 Alucent Biomedical Inc 1325 S Cliff Avenue PO Box 5045 Sioux Falls SD 571175045 471818349 Biotech Research SD N/A C 0 South Dakota State Medical Holding Company Inc 5300 South Broadband Lane Sioux Falls SD 57108 460401087 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 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 1 1 1 0 Schedule R, Part III: Q&M Properties, LLC dissolved effective June 30, 2021. National Rural ACO 4 LLC liquidated effective December 31, 2020.