2020-05-26T11:57:46-05:00 2019-06-30 450250958 Eide Bailly LLP 800 Nicollet Mall Ste 1300 Minneapolis MN 554027033 990 2018-07-01 460225483 Sacred Heart Health Services SACR 6056688000 501 Summit Street Yankton SD 57078 Julie Norton CFO Avera Health 6056688000 2020-05-11 1 Kim Hunwardsen CPA P00484560 6122536500 2020-05-11 216.147.181.49 2020-05-11 10:33:24 CD P D8A1E5117AA53286D53F57459EBB2DE5C7CA50FC F9BEE9501A3B4F00F190E63700B8BF2BC70C7B96 2018 2020-09-23 17:36:50Z Avera Sacred Heart Hospital Douglas R Ekeren 501 Summit Street Yankton SD 57078 146718303 0 0928 X www.averasacredheart.com X 1911 SD Promotion of Health 13 10 1367 368 0 0 966366 1255983 129437883 137428101 10647727 7363356 -370984 -201072 140680992 145846368 60000 400723 0 0 62159460 63191062 0 0 229852 66087656 69246991 128307116 132838776 12373876 13007592 336401545 347827204 57651198 55964597 278750347 291862607 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 115453014 400723 137444592 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. Avera Sacred Heart provides acute care and long-term healthcare services, of which there were 3,981 patient discharges, 98,714 outpatient visits, 1,041 swing-bed patient days, 1,434 newborn patient days, 296 Long term care patient discharges, 81,534 nursing home resident days, and 48,083 clinic visits. Following is a breakdown of these statistics by facility:Avera Sacred Heart Hospital3,127 Acute inpatient discharges541 Newborn patient discharges64 Swing bed patient discharges85,912 Outpatient visits298 Swing-bed patient days1,434 Newborn patient days27,803 Clinic visitsAvera Sacred Heart Majestic Bluffs275 Long term care patient discharges65,135 Long-term care resident daysAvera Creighton Hospital (CAH)161 Acute inpatient discharges88 Swing bed patient discharges12,802 Outpatient visits743 Swing-bed patient days20,280 Clinic visitsAvera Creighton Care Centre21 Long term care patient discharges16,399 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 $4,190,231.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. 115453014 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 1 174 0 1 1367 1 0 0 0 0 0 0 0 0 0 0 0 0 X 13 10 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 Ryan Loecker Chair 2.00 0.00 X X 0 0 0 Sr Debra Kolecka OSB Vice Chair 2.00 0.00 X X 0 0 0 Richard Strom MDBoard Member /Chief of Staff (thru Feb 2019) 10.00 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 Sr Patrick Leonard Murphy PBVM Board Member 2.00 0.00 X 0 0 0 Sr Lucille Welbig PBVM Board Member 2.00 2.50 X 0 0 0 Kevin Bray Board Member (thru Dec 2018) 2.00 0.00 X 0 0 0 Russ Diedrichsen Board Member 2.00 0.00 X 0 0 0 Tim Irwin Board Member (thru Dec 2018) 2.00 0.00 X 0 0 0 Sr Kathleen Crowley OSB Board Member 2.00 0.00 X 0 0 0 Michael Peterson MD Board Member & Physician 40.00 0.00 X 599293 0 37038 Wayne Kindle Board Member 2.00 0.00 X 0 0 0 Brian Steward Board Member 2.00 0.00 X 0 0 0 Bruce Reifenrath MDBoard Member/Chief of Staff (as of Mar 19) 10.00 0.00 X 0 0 0 Susan Fanta MDBoard Member & Physician (thru Dec 2018) 2.00 0.00 X 0 0 0 Douglas Ekeren President & CEO 2.00 40.00 X X 0 514267 38038 Jim Breckenridge CFO Avera Health;Sec/Treas 0.10 39.90 X 0 918859 34586 Anthony Erickson Exec Director-Senior Services 40.00 0.00 X 181342 0 37715 Lindsay Flannery VP Patient Care Services 40.00 0.00 X 182979 0 9690 Gregory Taylor MD Diagnostic Radiology 40.00 0.00 X 613631 0 44766 Steve Gutnik MD FACP Gastroenterology 40.00 0.00 X 796781 0 24891 Matthew G Winkelbauer MD Family Medicine/OB 40.00 0.00 X 546248 0 41097 Lawrence Leon Radiology 40.00 0.00 X 532988 0 36238 Wayne Scheidemann MD Orthopedic Surgeon 40.00 0.00 X 572008 0 23205 Jamie SchaeferFormer Sec/Treas & VP Finance 0.00 40.00 X 0 241629 40978 4025270 1674755 368242 69 1 1 0 Avera Health 3900 W Avera Dr Sioux Falls SD 57108 Administrative Services 20189762 Avera McKennan 1325 S Cliff Ave Sioux Falls SD 57105 Physician Services 1493595 Yankton Medical Clinic PC PO Box 706 Yankton SD 57078 Physician Services 1060252 Yankton Anesthesiology PC 1000 W 4th St Suite 13 Yankton SD 57078 Anesthesiologists 569981 Sioux Laundry Inc 510 Centennial Dr North Sioux City SD 57049 Laundry Services 468067 34 576992 360961 318030 1255983 Net patient service revenue 622110 134851054 134851054 Pharmacy revenue 900099 517855 517855 2059192 2059192 137428101 82619 82619 654372 871935 -217563 -217563 -217563 7115047 165690 0 0 7115047 165690 7280737 7280737 A/R Interest Income 900099 16491 16491 16491 145846368 137444592 0 7145793 X 400723 400723 1059766 636778 422988 139001 139001 48933752 47172603 1651300 109849 1988187 1879464 103964 4759 7569588 7048509 518473 2606 3500768 3319787 172496 8485 17921 17921 26728363 15805208 10917892 5263 35400 15590 5475 14335 1820154 1497875 321827 452 927194 335705 591489 2435171 2429175 5996 325801 301945 23182 674 342550 230453 109165 2932 1869563 1869563 7959750 7775704 182118 1928 1019193 870704 148489 Medical Supplies 19648585 19648585 Bad Debt Expense 4762901 4762901 Loan Forgiveness 385043 385043 Service Charges 118671 118671 850731 678590 93572 78569 132838776 115453014 17155910 229852 3023627 312504 25169274 21794949 2483341 2464492 1319871 811188 181472661 107073412 79627712 74399249 216508428 239350631 1168280 1067598 6537503 7064849 563509 561744 336401545 347827204 8528710 10457432 120971 203804 47520620 44600810 116613 72243 1364284 630308 57651198 55964597 X 265663805 278793354 12373467 12322014 713075 747239 278750347 291862607 336401545 347827204 X 13007592 1588202 -1483534 X X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 1 X 1282484 38285 41728 204509 1157988 1071080 28881 188014 5491 1282484 1071080 38729 -24812 13917 1071080 1045751 77699 -35356 17014 1071080 1013689 52266 -2578 17626 1045751 0.52980 0.47020 0 1 0 4521594 4521594 124330563 71337306 52993257 45267791 31507194 13760597 7352713 4228912 3123801 74399249 Assets limited to use - Avera Pooled Investments 239350631 F 239350631 Estimated third-party payor settlements 182069 Derivative liability 448239 630308 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 985486 985486 0.00770 14358930 9598035 4760895 0.03720 279912 272033 7879 0.00010 15624328 9870068 5754260 0.04500 14 8360426 7412631 947795 0.00740 3 232919 18449 214470 0.00170 4 6118879 4199266 1919613 0.01500 3 181923 181923 0.00140 24 14894147 11630346 3263801 0.02550 24 30518475 21500414 9018061 0.07050 5287 5287 0.00000 53083 53083 0.00040 24 24 0.00000 2677 2677 0.00000 621 621 0.00000 2176 2176 0.00000 956 956 0.00000 64824 64824 0.00040 1 4762901 0 32295556 30712257 1583299 X 1 1 2 1 Avera Sacred Heart Hospital 501 Summit Street Yankton SD 57078 www.avera.org/sacred-heart/ 10576 X X X 7 provider based clinics 2 Avera Creighton Hospital 1503 Main Street Creighton NE 68729 www.avera.org/creighton/ 490001 X X X X 1 provider based clinic and 6 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 Section C X See Section C X See Section C X X X X X X X 1 X 0 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 Section C X See Section C X See Section C X X X X X X X 1 X 0 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 during the tax year and as such the hospital has not taken specific actions with respect to the current implementation strategy. The following community health priority areas were identified and the following actions will be taken by the hospital during future years.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.* 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.* Provide an annual meal preparation and planning program.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 unit located on third floor of the Avera Sacred Heart Hospital Benedictine Center.* Actively recruit psychologists and/or certified nurse practitioners with specialties in behavioral health for the Avera Medical Group Behavioral Health Clinic.* Provide educational and informational opportunities for the community.* Implement the Avera Medical Group's opioid reduction strategies in the Avera Medical Group clinics in the Avera Sacred Heart Region.* Avera Medical Group Pain Management will implement quarterly behavioral health evaluations for all patients on a pain contract.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 Cost Avera Creighton Hospital Part V, Section B, Line 11: The community health needs assessment was completed during the tax year and as such the hospital has not taken specific actions with respect to the current implementation strategy. The following community health priority areas were identified and the following actions will be taken by the hospital during future years.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 communityHYPERTENSION* Explore options for increasing the number and location of blood pressure screenings in the community* Patient education campaign focused on definition and treatment of hypertensionDIABETES* 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 treatmentMany 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. Schedule H, Part V, Line 7a, 7b, and 10a: www.avera.org/about/community-health-needs-assessments/ Schedule H, Part V, 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: Charity care was converted to cost using the cost-to-charge ratio based on the Medicare Cost Report from the prior year. The amounts on lines 7e-i represent expenses reported in the general ledger and compiled using CBISA software. Part I, Ln 7 Col(f): Bad debt expense of $4,762,901 is included on Form 990, Part IX, line 25, column (A) but excluded for purposes of calculating this percentage. Part II, Community Building Activities: Sacred Heart Health Services provided a public school athletic trainer. This helps with the prevention of injuries, recognition of an injury requiring additonal medical attention, post-injury rehabilitation and education. Part III, Line 2: Bad debt expense is reported net of discounts and contractual allowances. A payment on an account previously written off reduces bad debt expense in the current year. Bad debt expense on line 2 is reported at charges as presented on the financial statements. Part III, Line 3: Avera Sacred Heart has several procedures in place to determine which patients would qualify for financial assistance, therefore the hospital feels confident that no amount of bad debt expense is attributable to patients eligible under the Organization's financial assistance policy. Part III, Line 4: The footnote to the Organization's financial statements that describes bad debt expenses can be found on page 11 of the attached financial statements. Part III, Line 8: 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. Avera Sacred Heart follows the CHA guidelines in reporting community benefits and therefore any Medicare shortfall (as calculated including our non-cost report entities) is excluded from our community benefit report. However, Medicare is the Organization's largest payer and patients with Medicare coverage are accepted regardless of whether or not a surplus or deficit is realized from providing the services. This basis therefore means providing Medicare services promotes access to healthcare services which is a key advantage for our community. 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: The brochure "Understanding Your Health Care Bill" is provided in visible locations experiencing high volumes of inpatient or outpatient registrations such as the admitting office, the billing/business office, and emergency department as well as the organization website. Patients are also made aware of possible eligibility when given the "Patient Rights and Responsibilities" brochure upon admission. The Patient Advocate works with uninsured/underinsured patients to enroll them in applicable social service programs and/or identify charity, county or risk pool eligibility. Part VI, Line 4: Avera Sacred Heart Hospital primarily serves the city and county of Yankton, SD and the surrounding South Dakota counties of Bon Homme, Charles Mix, Clay and Hutchinson, and Cedar County and Knox in Nebraska. Approximately 67% of all discharges are from Yankton County. In 2018, the population of Yankton County was estimated to be 22,869. Approximately 18.9% of the population is age 65 or older. The median household income in 2018 was estimated to be $54,694 and approximately 11.0% of residents are below the federal poverty level. 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 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 hour a day emergency services. 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 College students. The Hospital is also proud of the fact that 368 individuals chose to volunteer at the facility during fiscal year 2019. Part VI, Line 6: Avera is a sponsored ministry of the Benedictine and Presentation Sisters. The communities in which Avera Health 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 College 1105 W 8th Street Yankton SD 57078 460283336 501(c)(3) 400000 Fieldhouse 1 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 Michael Peterson MD Board Member & Physician 542475 0 51401 0 5417 0 13750 0 23288 0 636331 0 0 0 Douglas Ekeren President & CEO 0 411026 0 625 0 102616 0 13750 0 24288 0 552305 0 0 Jim Breckenridge CFO Avera Health;Sec/Treas 0 693359 0 1720 0 223780 0 13750 0 20836 0 953445 0 0 Anthony Erickson Exec Director-Senior Services 180168 0 270 0 904 0 9448 0 28267 0 219057 0 0 0 Lindsay Flannery VP Patient Care Services 182637 0 0 0 342 0 9144 0 547 0 192670 0 0 0 Gregory Taylor MD Diagnostic Radiology 472168 0 134023 0 7440 0 13750 0 31016 0 658397 0 0 0 Steve Gutnik MD FACP Gastroenterology 673892 0 97637 0 25252 0 13750 0 11141 0 821672 0 0 0 Matthew G Winkelbauer MD Family Medicine/OB 529508 0 15000 0 1740 0 13750 0 27347 0 587345 0 0 0 Lawrence Leon Radiology 453910 0 52527 0 26551 0 13750 0 22488 0 569226 0 0 0 Wayne Scheidemann MD Orthopedic Surgeon 507088 0 17100 0 47820 0 13750 0 9455 0 595213 0 0 0 Jamie SchaeferFormer Sec/Treas & VP Finance 0 241089 0 0 0 540 0 12491 0 28487 0 282607 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. Allison Diedrichsen Spouse of board member 29753 Employee compensation 0 Laura Alexander Child of officer 54699 Employee compensation 0 Katherine Schild Child of officer 54549 Employee compensation 0 Form 990, Part VI, Section A, line 2 Sr. Debra Kolecka, Jim Breckenridge, 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 Contract Labor: Program service expenses 1,708,488. Management and general expenses 0. Fundraising expenses 0. Total expenses 1,708,488. Purchased Services: Program service expenses 4,836,907. Management and general expenses 1,317,092. Fundraising expenses 5,263. Total expenses 6,159,262. Professional Fees: Program service expenses 1,598,073. Management and general expenses 0. Fundraising expenses 0. Total expenses 1,598,073. Repairs and Maintenance: Program service expenses 2,849,085. Management and general expenses 36,467. Fundraising expenses 0. Total expenses 2,885,552. Consulting: Program service expenses 615,159. Management and general expenses 0. Fundraising expenses 0. Total expenses 615,159. ACS Fees: Program service expenses 4,197,496. Management and general expenses 9,564,333. Fundraising expenses 0. Total expenses 13,761,829. Form 990, Part XI, line 9: Capital transfers, net -1,499,692. Change in fair value of interest rate swap -93,661. Other change in net assets held by Avera Health Foundation 109,819. 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 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 Surgical Associates Endoscopy Clinic LLC 310 S Pennsylvania St Aberdeen SD 57401 460461429 Surgical associates SD N/A 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 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 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 Q&M Properties 525 North Foster Mitchell SD 57301 731652049 Medical clinic building SD N/A Heart Hospital of South Dakota LLC 4500 W 69th Street Sioux Falls SD 57108 562143771 Healthcare services SD N/A Brookings Health System - Avera HME LLC 101 22nd Ave Suite 101 Brookings SD 57006 453204123 Medical Services - Home Medical Equipment SD N/A 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 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 Valley Health Services Inc 501 Summit Street Yankton SD 57078 460357149 Rental real estate SD Sacred Heart Health Services C 48030 878373 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 610 W 23rd St Ste 1 PO Box 38 Yankton SD 57078 460463155 Insurance SD N/A C 0 Alucent Medical 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 2600 W 49th Street Sioux Falls SD 57105 460401087 Insurance SD N/A C 0 DakotaCare Administrative Services Inc 2600 W 49th Street Sioux Falls SD 57105 460424322 Insurance SD N/A C 0 0 0 0 0 0 0 0 0 0 1 0 1 1 0 1 1 0 0 0 Lewis and Clark Health Education and Service Agency L 118831 Recorded in General Ledger Lewis and Clark Health Education and Service Agency M 197292 Recorded in General Ledger