2019-05-14T15:28:29-05:00 2018-06-30 450250958 Eide Bailly LLP 800 Nicollet Mall Ste 1300 Minneapolis MN 554027033 990 2017-07-01 460225483 Sacred Heart Health Services SACR 6056688000 501 Summit Street Yankton SD 57078 Jim Breckenridge CFO Avera Health 6056688000 2019-05-13 1 Kim Hunwardsen CPA P00484560 6122536500 2019-05-13 8.39.233.107 2019-05-13 16:34:19 CD P D8A1E5117AA53286D53F57459EBB2DE5C7CA50FC EFC25E59FA7409AE560978A003AFB9E955B778C6 2017 2019-02-21 02:37:17Z Avera Sacred Heart Hospital Douglas R Ekeren 501 Summit Street Yankton SD 57078 141398475 0 0928 X www.averasacredheart.com X 1911 SD Promotion of Health 15 13 1363 261 0 0 943887 966366 125620739 129437883 16159759 10647727 -333615 -370984 142390770 140680992 261829 60000 0 0 60973246 62159460 0 0 293157 61285915 66087656 122520990 128307116 19869780 12373876 325213601 336401545 61341554 57651198 263872047 278750347 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 107829669 60000 129441714 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 100-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 3,462 patient discharges, 91,169 outpatient visits, 1,477 swing-bed patient days, 1,693 nursery patient days, 82,535 nursing home resident days, and 44,516 clinic visits. Following is a breakdown of these statistics by facility:Avera Sacred Heart Hospital3,343 Acute patient discharges79,731 Outpatient visits732 Swing-bed patient days1,693 Newborn patient days24,453 Clinic visitsAvera Sacred Heart Majestic Bluffs66,824 Long-term care resident daysAvera Creighton Hospital (CAH)119 Acute patient discharges11,438 Outpatient visits745 Swing-bed patient days20,063 Clinic visitsAvera Creighton Care Centre15,711 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 $4,521,620.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. 107829669 1 1 0 1 0 0 0 0 1 1 1 1 0 0 1 1 0 1 0 0 0 0 0 0 1 0 1 1 1 1 1 0 0 0 0 0 1 1 0 0 0 0 0 0 1 1 1 0 0 1 146 0 1 1363 1 0 0 0 0 0 1 1 0 0 0 0 X 15 13 1 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 0 1 1 0 X X Jamie A Schaefer 6053223992 3900 W Avera Dr Ste 300 Sioux alls SD 57108 Wayne A Kindle Chair 2.00 0.00 X X 0 0 0 Ryan Loecker Vice Chair 2.00 0.00 X X 0 0 0 Sr Jeanne Annette Weber Board Member 2.00 0.00 X 0 0 0 Richard Strom MD Board Member/Chief of Staff 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 Board Member 2.00 2.00 X 0 0 0 Kevin Bray Board Member 2.00 0.00 X 0 0 0 Russ Deidrichsen Board Member 2.00 0.00 X 0 0 0 Tim Irwin Board Member 2.00 0.00 X 0 0 0 Sr Debra Kolecka OSB Board Member 2.00 5.00 X 0 0 0 Michael Peterson MD Board Member & Physician 40.00 0.00 X 597054 0 39647 Michael Pietila MD Board Member & Physician 2.00 0.00 X 0 0 0 Douglas Ekeren President & CEO 2.50 40.00 X X 0 502279 38156 Jim Breckenridge CFO Avera Health 0.10 39.90 X 0 887406 34116 Anthony Erickson Exec Director-Senior Services 40.00 0.00 X 182975 0 35706 Gregory Taylor MD Diagnostic Radiology 40.00 0.00 X 666978 0 43109 Steve Gutnik MD FACP Gastroenterology 40.00 0.00 X 774773 0 25269 Matthew G Winkelbauer MD Family Medicine/OB 40.00 0.00 X 546832 0 38410 Naila Qazi Physician 40.00 0.00 X 614713 0 41971 Wayne Schneidermann MD Orthopedic Surgeon 40.00 0.00 X 576269 0 24713 Jamie SchaeferFormer Sec/Treas & VP Finance 0.00 40.00 X 0 166618 25586 3959594 1556303 346683 69 1 1 0 Avera Health 3900 W Avera Dr Sioux Falls SD 57108 Administrative Services 21409143 Avera McKennan 1325 S Cliff Ave Sioux Falls SD 57105 Physician Services 1930863 Yankton Anesthesiology PC 1000 W 4th St Suite 13 Yankton SD 57078 Anesthesiologists 1070902 Yankton Medical Clinic PC PO Box 706 Yankton SD 57078 Physician Services 937586 Jalal U Akbar 2405 Brisbane Ln Plano TX 75075 Physician Services 500986 30 50718 246629 244547 424472 966366 Net patient service revenue 622110 125934874 125934874 Pharmacy revenue 900099 536744 536744 2966265 2966265 129437883 784801 784801 284519 696848 -412329 -412329 -412329 9862926 0 9862926 9862926 9862926 58149 50718 20635 37514 37514 A/R Interest Income 900099 3831 3831 3831 140680992 129441714 0 10272912 X 40000 40000 20000 20000 864837 642495 222342 129105 129105 47769800 45153296 2505107 111397 1962273 1818284 138045 5944 8020543 7226030 775367 19146 3412902 3184957 219300 8645 2739 2739 25595 25595 15968 15968 24505955 10212750 14292993 212 55816 31548 6389 17879 2172898 1558657 608861 5380 991292 270252 721040 2357806 2279067 78739 357589 304608 51748 1233 398582 276283 117985 4314 1857646 1857646 8245477 8245477 362358 275374 86984 Medical Supplies 18308860 18308860 Bad Debt Expense 5189912 5189912 Equipment Lease and Ren 281909 187140 94769 Licenses and Permits 48777 23827 24950 908477 594101 195369 119007 128307116 107829669 20184290 293157 5847797 3023627 18434942 25169274 845245 1168280 2642560 2483341 1840916 1319871 191517564 111889852 85601148 79627712 7239447 195665057 216508428 6537503 6537503 558986 563509 325213601 336401545 10677175 8528710 153681 120971 49016362 47520620 23903 116613 1470433 1364284 61341554 57651198 X 251556306 265663805 11637441 12373467 678300 713075 263872047 278750347 325213601 336401545 X 12373876 3210890 -706466 X X 0 1 X 1 0 X 0 0 0 0 0 0 0 0 1 15968 15968 0 Part II-B, Line 1: Avera Sacred Heart Hospital and Avera Creighton paid dues to organizations which have a portion of the dues attributed to lobbying activities. 0 1 X 1071080 28881 188014 5491 1282484 1071080 38729 -24812 13917 1071080 1045751 77699 -35356 17014 1071080 1013689 52266 -2578 17626 1045751 839365 51690 133464 10830 1013689 0.44850 0.55150 0 1 0 4546594 4546594 130129502 73027463 57102039 48927866 34015419 14912447 7913602 4846970 3066632 79627712 Assets limited to use - Avera Pooled Investments 216508428 F 216508428 Estimated third-party payor settlements 1009706 Derivative liability 354578 1364284 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 most of its sponsored organizations are considered nonprofit corporations as described in Section 501(c)(3) of the Internal Revenue Code and are exempt from federal income taxes on related income pursuant to Section 501(a) of the Code. These organizations are required to file a Return of Organization Exempt from Income Tax (Form 990) with the Internal Revenue Service (IRS). Avera Health and certain sponsored organizations also file an Exempt Organization Business Income Tax Return (Form 990T) with the IRS to report their unrelated business taxable income. 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 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. The federal Form 990T filings and taxable subisidiary returns for consolidated subsidiaries are no longer subject to federal tax examinations by tax authorities for years before 2015. Simply d'Vine 95992 50718 45274 3150 4572 2051 5040 2000 Roses Just Because 12875 12875 3822 108867 50718 58149 3150 4572 2051 5040 5822 20635 37514 1 1 X 1 X 1 X 1 1 1 0 0 2500 2629719 107639 2522080 0.02050 15365692 9725900 5639792 0.04580 2500 17995411 9833539 8161872 0.06630 16 424 10020190 7420746 2599444 0.02110 3 76124 19560 56564 0.00050 6 13384800 11778756 1606044 0.01300 3 118774 118774 0.00100 28 424 23599888 19219062 4380826 0.03560 28 2924 41595299 29052601 12542698 0.10190 1 1320 1320 0.00000 1 1320 1320 0.00000 1 5189912 0 29993169 30184878 -191709 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 15 1 0 0 1 X See part V Section C X See Part V Section C X 1 15 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 X 1 X 0 0 Avera Creighton Hospital 2 0 0 1 X X X X X X X X X 15 1 1 0 1 X See Part V Section C X See Part V Section C X 1 15 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 X 1 X 0 0 Avera Sacred Heart Hospital Part V, Section B, Line 5: Avera Sacred Heart Hospital worked closely with the SD Department of Health and also utilized Maximizing Excellence LLC to conduct focus groups. Careful consideration was taken to be sure that representatives from the community at large, the medically underserved, low-income and minority populations were included. Avera Creighton Hospital Part V, Section B, Line 5: Avera Creighton Hospital in conjunction with the North Central District Health Department used community stakeholder meetings, county focus groups and surveys targeted to specific population groups to determine potential areas to focus health improvement efforts on. Dr. Joseph Nitzke, a partner in Ionia Research, was contracted for data collection, compilation, analysis and presentation for the project. Avera Creighton Hospital Part V, Section B, Line 6a: Avera Creighton Hospital partnered with nine other hospitals in the North Central District Health Department including: Antelope Memorial Hospital, Avera St. Anthony's Hospital, Brown County Hospital, Cherry County Hospital, CHI Plainview, Niobrara Valley Hospital, Osmond General Hospital, Rock County Hospital and West Holt Memorial Hospital. Avera Sacred Heart Hospital Part V, Section B, Line 11: The 2015 Implementation Plan has addressed nutrition education, healthy choices, and awareness in the community and to continues to increase care coordination between the hospital and clinical providers in service of our mutual patients and colleagues.Nutrition:The first need identified is to increase nutrition education, healthy choices and community awareness of the issue. Avera Sacred Heart Hospital will implement quarterly nutrition education opportunities at various community events. Avera Sacred Heart Hospital will also provide nutrition tips such as portion control, healthy recipes and basic cooking tips quarterly on their Facebook page. Avera Sacred Heart Hospital will introduce and encourage updated vending options and snack bars to reflect the Good & Healthy SD vending criteria.Avera Sacred Heart Hospital was instrumental in establishing the Yankton Food Council which provides monthly education and recipes. The Yankton Food Council hosted a Conversation on Hunger at Avera Sacred Heart Hospital Pavilion in July 2017. Twenty-seven individuals representing twenty-three different agencies, non-profits,South Dakota Social Services, health care, and local business leaders gathered to discuss food insecurities specifically in Yankton and in the surrounding communities as well. Much of the discussion focused on lack of access to health food choices.Avera Sacred Heart Hospital continues its commitment to provide quality nutrition education in its service area.Increase Care Coordination:Avera Sacred Heart has established a Chief Medical Officer position that has the primary responsibility of developing and strengthening physician and clinic relationships.In April 2017, Avera Sacred Heart Hospital purchased the 10-bed Lewis and Clark Specialty Hospital and Medical Office Building in Yankton, South Dakota. Avera Sacred Heart Hospital now has a primary care clinic in Yankton staffed by one physician and two advanced care providers.Avera Sacred Heart Hospital requested from and granted access to electronic medical records within the hospital and various local clinics to facilitate a better flow of information for patient care where applicable and when appropriate. Avera Creighton Hospital Part V, Section B, Line 11: The most significant need identified was weight management, including increased nutrition education, healthy choices and awareness in the community and increased physical activity in the community. Creighton has continued to offer a community Wellness Center that is the only one in our service area. We also offer reduced rates for Senior Citizens, employees and subscribers paying an annual fee. Avera offers through our marketing an education departments news and educational articles on healthy eating and wellness choices. We also offer the "Know Your Numbers" every weekday. Our vending and dietary services offer healthy meals and meal choices. We have also redone our vending machines to make snack choices "healthier" offerings. Aging Population and Related illnesses - We continue to operate our 47-bed nursing home/skilled nursing facility, the Avera Creighton Care Centre. There we offer Adult Day Care, respite care and other services as appropriate.Housing/Environmental - The Creighton Chamber and Knox County Economic Development are groups we consider partners. We involve ourselves with those groups for economic development, recruitment, retention, and housing efforts. We also continue to lead or participate in emergency preparadeness including common farm accidents and weather events. Mental Health and substance abuse continue to be a challenge and we continue to offer on-site and telemedicine services. We also participate in Avera wide opioid and mental health initiates. 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 $5,189,912 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 10 of the attached financial statements. Part III, Line 8: Part III, Lines 5, 6, and 7: The Medicare revenues received (line 5), allowable costs (line 6), and the resulting shortfall (line 7) does not include a significant portion of the organization's expenses. These lines require use of the Medicare Cost Report as prepared by the required guidelines which disallows numerous costs of hospitals, particularly if they are part of an integrated system such as Sacred Heart Health Services. In these cases the entity must file a home office cost report which "steps down" overhead to non-cost report entities disproportionately to actual allowable share and essentially removing the costs from the hospital's cost report entirely. Examples of non-cost report entities operated by Sacred Heart Health Services include clinics, long-term care facilities, and other health care related businesses. There are also costs completely disallowed by cost report rules such as bad debt expense, marketing, CRNA's, and interest expense. In addition to these disallowed costs within the Hospital, Sacred Heart Health Services operates clinics, long-term care facilities, and other health care related businesses which do not file a cost report.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. Sacred Heart Health Services follows the CHA guidelines in reporting community benefits and therefore any Medicare shortfall 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. U.S Census statistics indicate that 17.4% of the City of Yankton's individual residents fall below the federal poverty guidelines. For fiscal year 2017, 46.1% of our revenue came from Medicare and Medicare Advantage plans, and 11.5% came from Medicaid and Medicaid Replacement plans. 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 261 individuals chose to volunteer at the facility during fiscal year 2018. 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) 40000 Healthcare education 1 0 Educational scholarships 4 20000 Part I, Line 2: The Organization only makes grants to other organizations which are also tax-exempt. Individual scholarship recipients are selected by the University School of Medicine according to its criteria. In fiscal year 2018, 4 medical school students were chosen for $5,000 scholarships. 0 0 0 0 0 0 0 0 0 Michael Peterson MD Board Member & Physician 541430 0 50201 0 5423 0 13500 0 26147 0 636701 0 0 0 Douglas Ekeren President & CEO 0 376003 0 1500 0 124776 0 13500 0 24656 0 540435 0 0 Jim Breckenridge CFO Avera Health 0 815781 0 0 0 71625 0 13500 0 20616 0 921522 0 0 Anthony Erickson Exec Director-Senior Services 171954 0 0 0 11021 0 9301 0 26405 0 218681 0 0 0 Gregory Taylor MD Diagnostic Radiology 506171 0 153061 0 7746 0 13500 0 29609 0 710087 0 0 0 Steve Gutnik MD FACP Gastroenterology 659834 0 96007 0 18932 0 13500 0 11769 0 800042 0 0 0 Matthew G Winkelbauer MD Family Medicine/OB 530086 0 15000 0 1746 0 13500 0 24910 0 585242 0 0 0 Naila Qazi Physician 386435 0 226803 0 1475 0 13500 0 28471 0 656684 0 0 0 Wayne Schneidermann MD Orthopedic Surgeon 516461 0 18600 0 41208 0 13500 0 11213 0 600982 0 0 0 Jamie SchaeferFormer Sec/Treas & VP Finance 0 151372 0 0 0 15246 0 8088 0 17498 0 192204 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 30806 Employee compensation 0 Mary Loecker Parent of board member 10291 Employee compensation 0 Laura Alexander Child of officer 38163 Employee compensation 0 Katherine Schild Child of officer 49845 Employee compensation 0 Form 990, Part VI, Section A, line 2 Sr. Lucille Welbig, 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 Repairs and Maintenance: Program service expenses 2,617,116. Management and general expenses 32,512. Fundraising expenses 0. Total expenses 2,649,628. Consulting: Program service expenses 616,029. Management and general expenses 7,700. Fundraising expenses 0. Total expenses 623,729. ACS Fees: Program service expenses 0. Management and general expenses 10,089,073. Fundraising expenses 0. Total expenses 10,089,073. Other Fees: Program service expenses 6,979,605. Management and general expenses 4,163,708. Fundraising expenses 212. Total expenses 11,143,525. Form 990, Part XI, line 9: Capital transfers, net -859,809. Change in fair value of interest rate swap 96,882. Net assets released from donor restrictions -172,417. Other change in net assets held by Avera Health Foundation 228,878. 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 N/A C 0 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 98874 Recorded in General Ledger Lewis and Clark Health Education and Service Agency M 219074 Recorded in General Ledger