2021-04-01T07:10:39-05:00 2020-06-30 450250958 EIDE BAILLY LLP 200 E 10TH ST STE 500 SIOUX FALLS SD 571046375 990 2019-07-01 460225414 ST MICHAEL'S HOSPITAL INC STMI 6055892100 410 WEST 16TH AVENUE TYNDALL SD 570662318 ASHLI DANILKO CEO 6055892100 2021-03-22 1 LAURIE HANSON CPA P00851848 6053391999 2021-03-22 2019 2022-09-23 18:48:47Z ASHLI DANILKO 410 WEST 16TH AVENUE TYNDALL SD 570662318 10254508 0 0928 X WWW.AVERA.ORG/ST-MICHAELS X 1966 SD TO PROVIDE HEALTHCARE SERVICES. 5 5 108 10 61899 -66 10500 41119 10670808 10082383 189372 95306 3200 33040 10873880 10251848 1121 48377 0 0 5034619 5384165 0 0 0 4024536 4295586 9060276 9728128 1813604 523720 15555884 20425456 772444 5217323 14783440 15208133 X IT IS THE MISSION OF ST. MICHAEL'S HOSPITAL TO PROVIDE READILY ACCESSIBLE HEALTH CARE TO THE PEOPLE OF BON HOMME COUNTY AND THE SURROUNDING AREAS. IN KEEPING WITH THE HERITAGE OF THE CATHOLIC CHURCH, ST. MICHAEL'S WILL AIM TO PROMOTE THE PHYSICAL, MENTAL, SOCIAL AND SPIRITUAL HEALTH OF ALL ITS PATIENTS. THE HEALTH CARE CENTERS WILL CONTINUE TO OFFER QUALITY SERVICES BASED ON COMMUNITY NEEDS AND FISCAL SOLVENCY. 0 0 7993583 48377 10053524 ST. MICHAEL'S HOSPITAL, INC. (SMH) OPERATES A 25-BED CRITICAL ACCESS HOSPITAL WITH PROVIDER BASED RURAL HEALTH CLINICS LOCATED IN TYNDALL AND IN AVON. PROVIDER STAFF, NURSING PERSONNEL, LABORATORY AND RADIOLOGY PERSONNEL ARE AVAILABLE AS NEEDED 24-HOURS A DAY, 7-DAYS A WEEK. DURING THE FISCAL YEAR ENDING JUNE 30, 2020, ACUTE PATIENT DAYS WERE 309 AND SWING-BED DAYS WERE 1,062. 7993583 1 0 0 0 0 0 0 0 0 1 1 1 0 0 0 1 1 0 0 0 0 0 0 0 0 0 1 1 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 15 0 1 108 1 1 1 0 0 0 0 0 0 0 0 0 0 0 X 5 5 0 0 0 0 0 0 0 1 0 0 0 1 1 1 1 1 1 1 1 0 X X LISA RONKE 6055892100 410 W 16TH AVE TYNDALL SD 570662318 DR MELVIN WALLINGA FAMILY PRACTICE PHYSICIAN 28.00 X 191946 0 32054 CAROL DEURMIER CEO 40.00 X 182684 0 31459 JACLYN DVORACEK PHARMACY DIRECTOR 36.00 X 134129 0 29797 JEREMIAH BERTSCHINGER PHARMACIST 40.00 X 125573 0 13773 TARA SCHAFERS PHARMACIST 40.00 X 122539 0 8449 ANGELA SCHNETZER PA-C 32.00 X 128432 0 0 LISA RONKE DIRECTOR OF FINANCE 40.00 X 60111 0 1411 STEVE JOHNSON CHAIRPERSON 1.00 X X 0 0 0 JOSEPH KOSTAL VICE CHAIRPERSON 1.00 X X 0 0 0 LAURIE JURRENS SECRETARY 1.00 X X 0 0 0 FATHER JOE FORCELLE MEMBER 1.00 X 0 0 0 RICHARD R PIER MEMBER 1.00 X 0 0 0 945414 0 116943 8 0 1 1 AVERA SACRED HEART HOSPITAL 501 SUMMIT YANKTON SD 57078 ADMIN, IT, OTHER SERVICES 704912 AVERA HEALTH 3900 W AVERA DRIVE SIOUX FALLS SD 57108 MEDICAL SERVICES, E SERVICES, OTHER SERV 319613 AVERA MCKENNAN 1325 S CLIFF AVE SIOUX FALLS SD 57117 MEDICAL SERVICES 211971 WELFL CONSTRUCTION 800 W 23RD ST YANKTON SD 57078 CONSTRUCTION SERVICES 160288 ARS PO BOX 39 SIOUX FALLS SD 57101 CONSTRUCTION SERVICES 135249 6 39319 1800 41119 PATIENT SERVICE FEES 621110 7661710 7661710 RETAIL PHARMACY 446110 2370290 2308391 61899 50383 50383 10082383 97466 97466 2950 0 2950 2950 2950 500 2660 -2160 -2160 -2160 BAD DEBT RECOVERIES 900099 30090 30090 30090 10251848 10053524 61899 95306 48377 48377 301696 301696 4165471 3722089 443382 129703 116346 13357 490344 438682 51662 296951 261386 35565 46800 46800 231935 76332 155603 2391 1390 1001 246357 80314 166043 147466 147466 121622 80692 40930 19851 15033 4818 5647 4297 1350 481103 321041 160062 84438 84438 SUPPLIES 2555542 2543959 11583 EQUIPMENT AND MAINTENAN 315016 259184 55832 DUES AND SUBSCRIPTIONS 37021 24461 12560 397 397 9728128 7993583 1734545 0 5844313 10525115 1172242 903359 390137 388332 30678 37619 10251386 6485866 3421917 3765520 4581597 4565511 115000 240000 15555884 20425456 772444 672701 3694230 850392 772444 5217323 X 14762324 15186947 21116 21186 14783440 15208133 15555884 20425456 X 523720 -89926 -9101 X 0 1 X 1 0 X 20893 70 20963 20763 130 20893 20668 95 20763 20538 130 20668 20403 135 20538 0.00000 1.00000 0.00000 0 0 5000 34375 39375 6046584 3394316 2652268 4058975 2999356 1059619 106452 92194 14258 3765520 INVESTMENT IN AVERA POOLED FUND 3594073 F INTEREST IN NET ASSETS OF AVERA HEALTH FOUNDATION 971438 F 4565511 X 10152751 -89926 -9101 -99027 10251778 70 70 10251848 9728128 0 9728128 0 9728128 PART V, LINE 4: THE INTENDED USE OF THE ORGANIZATION'S ENDOWMENT FUNDS IS TO PROVIDE FOR CAPITAL NEEDS THAT MAY ARISE. PART X, LINE 2: THE HOSPITAL BELIEVES THAT IT HAS 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 FINANCIAL STATEMENTS. THE HOSPITAL 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. PART XI, LINE 2D - OTHER ADJUSTMENTS: CHANGE IN INTEREST IN NET ASSETS OF FOUNDATION -9,101. PART XI, LINE 4B - OTHER ADJUSTMENTS: CONTRIBUTION FOR ENDOWMENT FUNDS 70. 1 1 X 1 X 1 X 1 1 1 0 0 110000 110000 0.01130 195033 168552 26481 0.00270 305033 168552 136481 0.01400 163839 2852 160987 0.01650 21170 6668 14502 0.00150 1837211 1096236 740975 0.07620 36202 36202 0.00370 2058422 1105756 952666 0.09790 2363455 1274308 1089147 0.11190 2 770 770 0.00010 2 770 770 0.00010 0 0 0 3650744 3662319 -11575 X 1 1 1 1 ST MICHAEL'S HOSPITAL INC 410 WEST 16TH AVENUE TYNDALL SD 570660027 WWW.AVERA.ORG/ST-MICHAELS 48584 X X X X ST MICHAEL'S HOSPITAL INC 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 X 1 X WWW.AVERA.ORG/LOCATIONS/PROFILE/ST-MICHAELS-HOSPITAL-AVERA/ X WWW.AVERA.ORG/LOCATIONS/PROFILE/ST-MICHAELS-HOSPITAL-AVERA/ X WWW.AVERA.ORG/LOCATIONS/PROFILE/ST-MICHAELS-HOSPITAL-AVERA/ X X X X X X 1 X 0 X X X X 1 X 0 0 ST. MICHAEL'S HOSPITAL, INC. PART V, SECTION B, LINE 5: THE HOSPITAL CONSULTED WITH COUNTY COMMUNITY HEALTH SERVICES, NURSES, MEDICAL PROVIDERS, SCHOOL OFFICIALS, BUSINESS LEADERS, RELIGIOUS LEADERS AND COMMUNITY MEMBERS. ST. MICHAEL'S HOSPITAL, INC. PART V, SECTION B, LINE 11: PURSUANT TO THE IMPLEMENTATION STRATEGY ADOPTED BY ST. MICHAEL'S HOSPITAL, INC., ALL NEEDS IDENTIFIED IN THE COMMUNITY HEALTH NEEDS ASSESSMENT COMPLETED DURING THE YEAR 2018 WILL BE ADDRESSED.1. IMPROVE ACCESS TO BEHAVIORAL HEALTH SERVICES AVAILABLE TO OUR COMMUNITY AT A LOCAL LEVEL: IN PARTNERSHIP WITH AVERA ECARE BEHAVIORAL HEALTH, ST. MICHAEL'S HOSPITAL PARTICIPATES IN ETRIAGE SERVICES AND OFFERS VIRTUAL BEHAVIORAL HEALTH APPOINTMENTS VIA TELEMEDICINE TECHNOLOGY. 2. PROMOTE HEALTHY LIFESTYLE CHOICES, PHYSICAL ACTIVITY AND WEIGHT MANAGEMENT: ST. MICHAEL'S HOSPITAL PROVIDES EDUCATION AND HEALTH PROMOTION INITIATIVES TO PROMOTE HEALTHY LIFESTYLE CHOICES, ADDRESS PHYSICAL INACTIVITY AND ENCOURAGE WEIGHT MANAGEMENT. ST.MICHAEL'S HOSPITAL CONTINUES TO OFFER NUTRITIONAL EDUCATION AND WELLNESS CENTER ACTIVITIES AND CLASSES. THE FACILITY COLLABORATES WITH LOCAL REPRESENTATIVES TO PARTICIPATE IN THE HEALTHY HOMETOWN INITIATIVE WITH WELLMARK.SOME OF THE SERVICES PROVIDED WERE LIMITED DUE TO THE COVID 19 PANDEMIC. ST. MICHAEL'S HOSPITAL, INC. PART V, SECTION B, LINE 13H: PRESUMPTIVE ELIGIBILITY IS UTILIZED AS A LAST RESORT. ST. MICHAEL'S HOSPITAL, INC. PART V, SECTION B, LINE 16J: A SUMMARY OF THE FINANCIAL ASSISTANCE POLICY IS POSTED IN THE EMERGENCY ROOM, RECEPTION AREA AND WAITING AREAS. STAFF DISCUSS THE AVAILABILITY OF THE FACILITY'S FINANCIAL ASSISTANCE POLICY WITH PATIENTS UPON ADMISSION. NOTICE IS ALSO INCLUDED IN PAYMENT REMINDER LETTERS AND IN STATEMENTS. ST. MICHAEL'S HOSPITAL, INC. PART V, SECTION B, LINE 24: THE HOSPITAL FINANCIAL ASSISTANCE POLICY DOES NOT COVER ELECTIVE PROCEDURES. THE HOSPITAL MAY HAVE CHARGED FAP ELIGIBLE PATIENTS GROSS CHARGES FOR SERVICES THAT ARE NOT COVERED UNDER THE FINANCIAL ASSISTANCE POLICY. PART V. SECTION B, LINE 7A THE COMMUNITY HEALTH NEEDS ASSESSMENT IS AVAILABLE ATHTTPS://WWW.AVERA.ORG/LOCATIONS/PROFILE/ST-MICHAELS-HOSPITAL-AVERA/ ANDHTTPS://WWW.AVERA.ORG/ABOUT/COMMUNITY-HEALTH-NEEDS-ASSESSMENTS/#MICHAEL PART V. SECTION B, LINE 10A THE IMPLEMENTATION STRATEGY IS AVAILABLE UPON REQUEST AND ATHTTPS://WWW.AVERA.ORG/ABOUT/COMMUNITY-HEALTH-NEEDS-ASSESSMENTS/#MICHAEL 1 1 - BON HOMME FAMILY PRACTICE CLINIC 130 MAIN STREET AVON SD 57315 FAMILY PRACTICE CLINIC PART I, LINE 3C: IN ADDITION TO THE USE OF FPG TO DETERMINE ELIGIBILITY FOR FREE OR DISCOUNTED CARE, SMH ALSO LOOKS AT THE PATIENT'S ASSETS, MEDICAL INDIGENCY, INSURANCE STATUS AND ELIGIBILITY FOR MEDICARE/MEDICAID. BEING IN A RURAL COMMUNITY WITH A SMALL POPULATION, SMH MAY ALSO USE KNOWN INFORMATION OF A PATIENT'S HARDSHIPS IN MAKING THE FINAL DETERMINATION. PRESUMPTIVE ELIGIBILITY IS UTILIZED AS A LAST RESORT. PART I, LINE 7: CHARITY CARE EXPENSE WAS CONVERTED TO COST ON LINE 7A BASED ON AN OVERALL COST-TO-CHARGE RATIO ADDRESSING ALL PATIENT SEGMENTS. LINE 7B WAS OBTAINED UTILIZING THE MEDICAID AND MEDICARE COST REPORTS. LINES 7E, 7F, AND 7I WERE OBTAINED UTILIZING THE ACTUAL GENERAL LEDGER SYSTEM. LINE 7G WAS OBTAINED FROM THE MEDICARE COST REPORT. PART I, LINE 7G: PHYSICIAN CLINIC COSTS ARE INCLUDED IN SUBSIDIZED HEALTH SERVICES. REVENUES OF $728,031 AND COSTS OF $1,310,880 WERE INCLUDED FOR A NET COMMUNITY BENEFIT OF $582,849. PART II, COMMUNITY BUILDING ACTIVITIES: SMH IS INVOLVED WITH THE AREA CHAMBER OF COMMERCE AND ROTARY CLUB. SMH WORKS TO ENHANCE THE QUALITY OF LIFE AND EMPOWER ITS PATIENTS, CARE-GIVERS AND COMMUNITY WITH THE RESOURCES THEY NEED WHEN THEY NEED THEM. SMH ALSO PROVIDES HEALTHCARE CAREER EDUCATION TO PROMOTE HEALTHCARE CAREERS AND RURAL HEALTH. PART III, LINE 2: BAD DEBT EXPENSE IS MADE UP OF THE ACTUAL ACCOUNTS THAT ARE WRITTEN OFF DURING THE YEAR AS WELL AS A CHANGE IN THE ESTIMATE FOR PATIENT ACCOUNTS THAT ARE STILL OUTSTANDING ON THE BOOKS AND RECORDS OF THE FACILITY. BAD DEBT RECOVERIES ARE POSTED AS A REDUCTION TO BAD DEBT EXPENSE. DURING FISCAL YEAR 2020, THE BAD DEBT RECOVERIES EXCEEDED BAD DEBT EXPENSE. PART III, LINE 4: THE FOOTNOTE THAT DESCRIBES BAD DEBT EXPENSE IS ON PAGE 8 OF THE AUDITED FINANCIAL STATEMENT. PART III, LINE 8: MEDICARE ALLOWABLE COST OF CARE WAS CALCULATED FROM THE MEDICARE COST REPORT FOR FISCAL YEAR ENDING 6/30/20. MANY PATIENTS IN OUR SERVICE AREA QUALIFY FOR MEDICARE. THE FACILITY PROVIDES SERVICES TO THESE PATIENTS EVEN THOUGH MEDICARE REIMBURSEMENT IS NOT SUFFICIENT TO COVER THE COST OF PROVIDING THIS CARE. PROVIDING SERVICES TO THIS POPULATION PROMOTES ACCESS TO HEALTHCARE SERVICES WHICH ARE NEEDED IN OUR COMMUNITY, THEREBY PROVIDING A BENEFIT TO OUR COMMUNITY. PART III, LINE 9B: SMH PROVIDES CARE TO PATIENTS WHO MEET CERTAIN CRITERIA UNDER ITS CHARITY CARE POLICY WITHOUT CHARGE OR AT AMOUNTS LESS THAN ITS ESTABLISHED RATES. THE HOSPITAL DOES NOT PURSUE COLLECTIONS OF AMOUNTS DETERMINED TO QUALIFY AS CHARITY CARE. PART VI, LINE 2: IN ORDER TO DETERMINE NEEDS OF THE COMMUNITY WE SERVE, ST. MICHAEL'S HOSPITAL CONDUCTS PATIENT SURVEYS VIA TELEPHONE THROUGH HEALTHSTREAMS, AND OUR PROVIDERS HAVE MONTHLY MEETINGS FOR CLINIC AND MEDICAL STAFF AT WHICH TIME MAY DISCUSS NEEDS THAT ARE IDENTIFIED THROUGH THE SURVEYS AND THROUGH OFFICE VISITS. PART VI, LINE 3: THE SMH STAFF ASSISTS PATIENTS WHO MAY BE ELIGIBLE FOR FINANCIAL ASSISTANCE BY DISCUSSING THE AVAILABILITY OF VARIOUS GOVERNMENT BENEFITS, SUCH AS MEDICAID OR STATE PROGRAMS, AND ASSISTING THE PATIENT WITH QUALIFICATION FOR SUCH PROGRAMS WHERE APPLICABLE. THE PROGRAMS ARE DISCUSSED AT THE TIME OF ADMISSION AND PATIENT REQUEST. POSTERS HIGHLIGHTING VARIOUS ASSISTANCE OPTIONS (I.E. ALL WOMEN COUNT) ARE POSTED IN THE ADMISSION AREA. SMH STAFF ALSO DISCUSS THE AVAILABILITY OF ITS CHARITY CARE POLICY WITH PATIENTS UPON ADMISSION. PART VI, LINE 4: SMH SERVES A RURAL POPULATION IN BON HOMME COUNTY WHICH INCLUDES THE CITIES OF TYNDALL, AVON, TABOR AND SPRINGFIELD. THERE IS ONE OTHER HOSPITAL IN BON HOMME COUNTY LOCATED IN SCOTLAND. THE 2019 CENSUS FOR BON HOMME COUNTY REPORTED 6901 PEOPLE WITH 14.1% OF THE POPULATION AT 100% POVERTY OR BELOW. 20.8% OF BON HOMME COUNTY'S POPULATION IS AGE 65 OR OLDER (COMPARED TO 17.2%) IN THE STATE OF SOUTH DAKOTA. PART VI, LINE 5: SMH'S GOVERNING BODY IS COMPRISED OF PERSONS WHO RESIDE IN BON HOMME COUNTY WHO ARE NEITHER EMPLOYEES NOR CONTRACTORS OF THE ORGANIZATION, NOR FAMILY MEMBERS THEREOF. THE ORGANIZATION EXTENDS MEDICAL STAFF PRIVILEGES TO ALL QUALIFIED PHYSICIANS IN ITS COMMUNITY FOR SOME OR ALL OF ITS DEPARTMENTS. SMH APPLIES SURPLUS FUNDS TO IMPROVEMENTS IN PATIENT CARE AND PROVIDES READILY ACCESSIBLE HEALTH CARE TO THE PEOPLE OF BON HOMME COUNTY AND THE SURROUNDING AREA.SMH PROVIDES A VARIETY OF COMMUNITY BENEFIT HEALTH ACTIVITIES AT NO COST OR LESS THAN COST. THESE ACTIVITIES INCLUDE WELLNESS PROGRAMS, NUTRITION EDUCATION, FOOT CLINICS, CPR CLASSES, AND BLOOD PRESSURE SCREENINGS. A VARIETY OF PROGRAMS ARE PROVIDED AT NO CHARGE FOR THE CHILDREN IN OUR COMMUNITIES SUCH AS THE IMPACT CONCUSSION PROGRAM, FLU SHOT CLINICS, AND ATHLETIC SCREENINGS. SMH ALSO PROVIDES ATHLETIC PHYSICALS FOR STUDENTS AT A DISCOUNTED RATE. SMH PROVIDES A NURSE ON AN AS NEEDED BASIS FOR AMBULANCE TRANSFERS AT NO COST TO THE LOCAL AMBULANCE SERVICE. APPROXIMATELY 17 CLIENTS WERE SERVED DURING THE FISCAL YEAR ENDED 6/30/20.SMH PROVIDED FINANCIAL AND IN KIND DONATIONS FOR VARIOUS COMMUNITY NEEDS SUCH AS MEETING ROOM AVAILABILITY, MEDICAL STAFF COVERAGE AT LOCAL SPORTING EVENTS, AND HEALTH EDUCATION, INCLUDING HEALTH PROFESSION EDUCATION FOR STUDENTS GOING INTO THE HEALTHCARE FIELD. SMH PROVIDES EMERGENCY SERVICES 24-HOURS A DAY, 7-DAYS A WEEK. IN ADDITION TO NURSING STAFF, A MIDLEVEL PROVIDER AND/OR PHYSICIAN ARE IN HOUSE OR ON CALL AT ALL TIMES TO PROVIDE CARE TO ANYONE PRESENTING WITH AN EMERGENT CONDITION REGARDLESS OF THEIR ABILITY TO PAY. FOR FISCAL YEAR ENDED 6/30/20, THERE WERE 679 PATIENTS WHO RECEIVED EMERGENCY CARE AT SMH. SMH ALSO MAKES AVAILABLE E-EMERGENCY SERVICES THROUGH AN ARRANGEMENT WITH AVERA HEALTH WHEREBY EMERGENCY PHYSICIANS AND OTHER SPECIALISTS ARE AVAILABLE VIA VIDEO CONFERENCING TO ASSIST THE MEDICAL STAFF AND NURSES WITH PATIENTS PRESENTING TO THE SMH EMERGENCY ROOM. THE E-EMERGENCY SERVICES ARE PROVIDED AT NO COST TO THE PATIENT. 38 PATIENTS BENEFITED FROM THE E-EMERGENCY SERVICES DURING THE FISCAL YEAR ENDED 6/30/2020. PART VI, LINE 6: SMH IS A MANAGED FACILITY OF AVERA HEALTH. AVERA HEALTH AND THE HOSPITAL WORK COOPERATIVELY TO ENHANCE HEALTHCARE THROUGHOUT THE COMMUNITY SERVED BY THE HOSPITAL. AS A MANAGED FACILITY, SMH IS ABLE TO PARTICIPATE IN AVERA E-CARE SERIES. THESE SERVICES INCLUDE AVERA E-EICU, E-EMERGENCY, E-PHARMACY AND E-CONSULT. THESE SERVICES ALLOW RURAL PATIENTS TO BE CARED FOR AT THEIR LOCAL HOSPITALS, PROVIDE RURAL HOSPITALS ACCESS TO IMMEDIATE SPECIALTY CARE AND SUPPORT, AND HELP REDUCE HEALTH CARE COSTS AND TRAVEL. SMH ALSO HAS ACCESS TO "BACK OFFICE" SUPPORT SERVICES, SUCH AS LEGAL CONSULTATION, QUALITY BENCHMARKING, CODING, COMPUTER SERVICES, CONTRACT NEGOTIATIONS, ADMINISTRATIVE CONSULTATION, GROUP PURCHASING, HUMAN RESOURCES ASSISTANCE AND MANY OTHER SERVICES. AVERA HEALTH IS ABLE TO PROVIDE THESE SERVICES TO SMH AT A COST BELOW THAT WHICH THE HOSPITAL COULD OTHERWISE ACHIEVE. IN TURN, LOCAL CAREGIVERS ARE ABLE TO DEVOTE MORE RESOURCES TO PATIENT CARE. AVERA HEALTH AND SMH DEDICATE RESOURCES TO ENDEAVORS THAT MAKE A POSITIVE DIFFERENCE TO IMPROVE THE HEALTH OF THE COMMUNITIES THEY SERVE. THESE ACTIVITIES INCLUDE LEADERSHIP DEVELOPMENT AND TRAINING FOR COMMUNITY MEMBERS, ECONOMIC DEVELOPMENT, PHYSICAL IMPROVEMENTS IN THE COMMUNITY, CONTRIBUTIONS TO NONPROFIT COMMUNITY ORGANIZATIONS, NONPROFIT EVENT SPONSORSHIPS, DONATED MEDICAL SUPPLIES, COMMUNITY HEALTH EDUCATION AND SUPPORT GROUPS, HEALTH SCREENINGS, FLU-SHOT CLINICS, COMMUNITY HEALTH EDUCATION AND VARIOUS OTHER ACTIVITIES. 1 SOUTH DAKOTA COMMUNITY FOUNDATION PO BOX 296 PIERRE SD 57501 460398115 501(C)(3) 26000 SCHOLARSHIP FUND 1 PART I, LINE 2: FUNDS WERE TRANSFERRED TO THE SOUTH DAKOTA COMMUNITY FOUNDATION TO ESTABLISH A SCHOLARSHIP FUND FOR INDIVIDUALS PURSUING A DEGREE IN THE MEDICAL FIELD. ST. MICHAEL'S HOSPITAL, INC., RECEIVES PERIODIC REPORTS SHOWING THE ACTIVITY WITHIN THE FUND, ALLOWING THE ORGANIZATION TO ENSURE FUNDS ARE USED AS INTENDED. X X X 0 0 0 0 0 0 0 0 0 DR MELVIN WALLINGA FAMILY PRACTICE PHYSICIAN 190758 0 0 0 1188 0 7905 0 24149 0 224000 0 0 0 CAROL DEURMIER CEO 173785 0 4220 0 4679 0 9221 0 23407 0 215312 0 0 0 JACLYN DVORACEK PHARMACY DIRECTOR 133968 0 0 0 161 0 5648 0 24149 0 163926 0 0 0 SCHEDULE J LINE 3 CAROL DEURMIER, CEO, IS COMPENSATED THROUGH AN ARRANGEMENT WITH AVERA SACRED HEART HOSPITAL, 501 SUMMIT STREET, YANKTON, SD 57078. FORM 990, PART VI, SECTION A, LINE 8B THE BOARD OF DIRECTOR COMMITTEES ARE ADVISORY IN NATURE ONLY AND DO NOT HAVE AUTHORITY TO ACT ON BEHALF OF THE GOVERNING BODY. FORM 990, PART VI, SECTION B, LINE 11B THE CEO AND CFO REVIEW THE 990. THE 990 IS THEN PROVIDED TO EACH BOARD MEMBER FOR THEIR REVIEW PRIOR TO THE ACTUAL FILING OF THE 990. FORM 990, PART VI, SECTION B, LINE 12C ST. MICHAEL'S HOSPITAL CONFLICT OF INTEREST POLICY COVERS ANY DIRECTOR/TRUSTEE, OFFICER, MEMBER OF A COMMITTEE WITH BOARD-DELEGATED POWERS, MEMBER OF MANAGEMENT WHO HAS A DIRECT OR INDIRECT FINANCIAL INTEREST, CEO AND CFO AS WELL AS THEIR FAMILY MEMBERS. SMH REQUIRES ANY DIRECTOR/TRUSTEE, BOARD COMMITTEE MEMBER, OFFICER AND MEMBER OF MANAGEMENT TO DISCLOSE THE EXISTENCE OF A FINANCIAL INTEREST, OTHER ACTUAL OR POSSIBLE CONFLICT OF INTEREST AND ALL MATERIAL FACTS ANNUALLY BY COMPLETING A DISCLOSURE STATEMENT; AND IF A CONFLICT OF INTEREST ARISES AFTER THE COMPLETION OF THE ANNUAL DISCLOSURE, AT THE TIME THE NEW CONFLICT ARISES. THE BOARD OF DIRECTORS MAKES THE DETERMINATION AS TO WHETHER A CONFLICT OF INTEREST EXISTS. THE BOARD OF DIRECTORS ADDRESSES CONFLICT OF INTERESTS VIA A FORMALIZED PROCEDURE. THIS PROCEDURE MAY INCLUDE A PRESENTATION BY THE INTERESTED PERSON, BUT EXCLUDES THE INTERESTED PERSON FROM FURTHER DISCUSSION OR VOTING ON THE TRANSACTION OR ARRANGEMENT THAT MAY CONSTITUTE A CONFLICT OF INTEREST. THE BOARD OF DIRECTORS ALSO INCLUDE A STANDING AGENDA ITEM AT THE BEGINNING OF EACH MEETING WHICH REQUIRES THE DISCLOSURE OF POTENTIAL CONFLICT OF INTEREST FOR ANY ITEMS INCLUDED ON THE AGENDA. FORM 990, PART VI, SECTION B, LINE 15 AVERA SACRED HEART HEALTH SERVICES AND SMH'S BOARD OF DIRECTORS USE COMPARABILITY DATA TO DETERMINE APPROPRIATE COMPENSATION OF THE CEO BASED ON EXPERIENCE AND PERFORMANCE. THE COMPENSATION AMOUNT IS APPROVED ANNUALLY BY THE BOARD OF DIRECTORS. THE CEO DETERMINES THE COMPENSATION FOR OTHER MEMBERS OF MANAGEMENT INCLUDING THE CFO BASED ON AN ANNUAL PERFORMANCE APPRAISAL AND USE OF COMPARABILITY DATA. FORM 990, PART VI, SECTION C, LINE 19 THE FACILITY MAKES THE CONFLICT OF INTEREST POLICY AND BYLAWS AVAILABLE TO THE GENERAL PUBLIC UPON REQUEST. FORM 990, PART XI, LINE 9: CHANGE IN INTEREST IN NET ASSETS OF FOUNDATION -9,101.