2017-03-29T10:02:46-05:00 2016-06-30 450250958 EIDE BAILLY LLP 200 EAST 10TH ST PO BOX 5125 SIOUX FALLS SD 571175125 990 2015-07-01 460225414 ST MICHAEL'S HOSPITAL INC STMI 6055892100 410 WEST 16TH AVENUE TYNDALL SD 570662318 CAROL DEURMIER CEO 6055892100 2017-03-17 1 LAURIE HANSON P00851848 6053391999 2017-03-17 2015 2021-01-29 14:40:06Z CAROL DEURMIER 410 WEST 16TH AVENUE TYNDALL SD 570662318 9307680 0 0928 X WWW.AVERA.ORG/ASH/STMICHAELS X 1966 SD TO PROVIDE HEALTHCARE SERVICES. 6 6 94 44 112161 0 24728 14780 9142216 9250092 55884 38758 3513 4050 9226341 9307680 0 0 0 0 3989757 4102847 0 0 0 4031725 4617384 8021482 8720231 1204859 587449 10546490 10875684 1007419 799427 9539071 10076257 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 7734930 9137931 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, 2016, ACUTE PATIENT DAYS WERE 374 AND SWING-BED DAYS WERE 788. 7734930 1 0 0 0 0 0 0 0 0 1 1 1 0 0 1 1 1 0 0 0 0 0 0 0 0 0 1 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 21 0 1 94 1 1 1 0 0 0 0 0 0 0 0 0 X 6 6 1 0 0 0 0 0 0 1 0 0 0 1 1 1 1 1 1 1 1 0 X LISA RONKE 6055892100 410 W 16TH AVE TYNDALL SD 570662318 MARTY KOCH CHAIRPERSON 1.00 X X 0 0 0 STEVE JOHNSON VICE CHAIRPERSON 1.00 X X 0 0 0 JOE KOSTAL 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 ERNIE BURES MEMBER 1.00 X 0 0 0 CAROL DEURMIER CEO 50.00 X 148783 0 14251 LISA RONKE DIRECTOR OF FINANCE 40.00 X 50995 0 3833 DR MELVIN WALLINGA FAMILY PRACTICE PHYSICIAN 40.00 X 179266 0 19090 JACLYN DVORACEK PHARMACY DIRECTOR 36.00 X 124126 0 12162 JEREMIAH BERTSCHINGER RETAIL PHARMACY COORDINATOR 40.00 X 121540 0 3163 TARA SCHAFERS PHARMACIST 40.00 X 108225 0 16272 STEVE MACH PHYSICAL THERAPIST 40.00 X 101535 0 12830 834470 0 81601 6 0 1 1 AVERA SACRED HEART HOSPITAL 501 SUMMIT YANKTON SD 57078 MANAGEMENT, OCCUPATIONAL&SPEECH THERAPY, 634206 AVERA HEALTH 3900 W AVERA DRIVE SIOUX FALLS SD 57108 MEDICAL SERVICES (U/S,ICU,NUC,SLEEP LAB) 134408 2 13799 981 14780 PATIENT SERVICE FEES 621110 6645912 6645912 RETAIL PHARMACY 446110 2363206 2251045 112161 CHNG IN INT-FOUNDATION 900099 124769 124769 MISCELLANEOUS 900099 94300 94300 MEDICAID EMR INCENTIVE 900009 21905 21905 9250092 6306 6306 4050 0 4050 4050 4050 31052 1400 0 0 31052 1400 32452 32452 9307680 9137931 112161 42808 254085 254085 3168990 2917705 251285 108689 100342 8347 343777 317060 26717 227306 205865 21441 114113 114113 35800 35800 63919 58378 5541 6732 2155 4577 139034 65546 73488 125659 125659 103831 102774 1057 15755 10131 5624 3644 2574 1070 543343 543343 79670 79670 SUPPLIES 2761989 2761989 EQUIPMENT AND MAINTENAN 346076 305656 40420 BAD DEBT 232789 232789 DUES AND SUBSCRIPTIONS 43730 28204 15526 1300 749 551 8720231 7734930 985301 0 1578353 2836022 1123482 919875 409533 372807 72919 35484 9764263 5699142 4696322 4065121 638346 508061 2027535 2138314 10546490 10875684 773323 467236 54096 32191 180000 300000 1007419 799427 X 9506283 10044489 12385 11230 20403 20538 9539071 10076257 10546490 10875684 587449 -50263 0 X 0 1 X 1 0 X 20403 135 20538 20273 130 20403 20143 130 20273 19898 245 20143 19638 260 19898 1.00000 0 0 5000 34375 39375 5688004 2381111 3306893 3930432 3240123 690309 106452 77908 28544 4065121 INTEREST IN AVERA POOLED INVESTMENT FUNDS 1507665 F INTEREST IN NET ASSETS OF AVERA HEALTH FOUNDATION 630649 F 2138314 ESTIMATED 3RD PARTY PAYOR SETTLEMENTS 300000 300000 X 9025648 -50263 -232789 -283052 9308700 -1020 -1020 9307680 8487442 0 8487442 232789 232789 8720231 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 IS ORGANIZED AS A SOUTH DAKOTA NONPROFIT CORPORATION AND HAS BEEN RECOGNIZED BY THE INTERNAL REVENUE SERVICE (IRS) AS EXEMPT FROM FEDERAL INCOME TAXES UNDER INTERNAL REVENUE CODE SECTION 501(C)(3). THE HOSPITAL IS ANNUALLY REQUIRED TO FILE A RETURN OF ORGANIZATION EXEMPT FROM INCOME TAX (FORM 990) WITH THE IRS. IN ADDITION, THE HOSPITAL IS SUBJECT TO INCOME TAX ON NET INCOME THAT IS DERIVED FROM BUSINESS ACTIVITIES THAT ARE UNRELATED TO ITS EXEMPT PURPOSE. THE HOSPITAL FILES AN EXEMPT ORGANIZATION BUSINESS INCOME TAX RETURN (FORM 990T) WITH THE IRS TO REPORT ITS UNRELATED BUSINESS TAXABLE INCOME. 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. THE HOSPITAL'S FEDERAL FORM 990T FILINGS ARE NO LONGER SUBJECT TO FEDERAL TAX EXAMINATIONS BY TAX AUTHORITIES FOR YEARS BEFORE 2013. PART XI, LINE 2D - OTHER ADJUSTMENTS: BAD DEBT EXPENSE -232,789. PART XI, LINE 4B - OTHER ADJUSTMENTS: CONTRIBUTION FOR ENDOWMENT FUNDS 135. CONTRIBUTION FOR SPECIFIC PURPOSE 846. NET ASSETS RELEASED FOR CAPITAL ACQUISTIONS -2,001. PART XII, LINE 4B - OTHER ADJUSTMENTS: BAD DEBT EXPENSE 232,789. 1 1 X 1 X 1 X 1 0 1 1 33 27000 27000 0.00320 228485 223030 5455 0.00060 33 255485 223030 32455 0.00380 1491 143770 3381 140389 0.01650 8 9922 2000 7922 0.00090 562 1311468 578465 733003 0.08640 158 10351 10351 0.00120 2219 1475511 583846 891665 0.10500 2252 1730996 806876 924120 0.10880 748 748 0.00010 748 748 0.00010 0 232789 81476 3079568 3099392 -19824 X 1 1 1 1 ST MICHAEL'S HOSPITAL INC 410 WEST 16TH AVENUE TYNDALL SD 570660027 HTTP://WWW1.AVERA.ORG/ASH/STMICHAELS/ 48584 X X X X ST MICHAEL'S HOSPITAL INC 1 0 0 1 X X X X X X X X 15 1 0 0 1 X WWW.AVERA.ORG/ST-MICHAELS/ X 1 15 1 WWW.AVERA.ORG/ST-MICHAELS/ 0 0 1 X 150.000000000000 400.000000000000 X X X X 1 1 X X X 1 X WWW.AVERA.ORG/ST-MICHAELS/ X WWW.AVERA.ORG/ST-MICHAELS/ X WWW.AVERA.ORG/ST-MICHAELS/ X X X X X 1 X 0 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 ENDED JUNE 30, 2016 WILL BE ADDRESSED. 1. ESTABLISH A ROBUST RECRUITMENT INITIATIVE TO MAINTAIN ACCESS TO CARE LOCALLY TO SAVE COMMUNITY MEMBERS TIME AND DOLLARS ASSOCIATED WITH SAVED TRAVELS. 2. PROMOTE ADVANCE DIRECTIVES TO INCREASE NUMBER OF COMMUNITY MEMBERS WHO HAVE ADVANCE DIRECTIVES IN PLACE WHICH CAN ENSURE THAT THEIR WISHES AS A PATIENT ARE KNOWN AND HONORED.EFFORTS TO ADDRESS THESE ISSUES HAVE NOT OCCURRED AS OF THE FILING OF THIS RETURN DUE TO TIMING. ST. MICHAEL'S HOSPITAL, INC. PART V, SECTION B, LINE 16I: A SUMMARY OF THE CHARITY CARE POLICY IS POSTED IN THE EMERGENCY ROOM, RECEPTION AREA AND WAITING AREAS. STAFF DISCUSS THE AVAILABILITY OF THE FACILITY'S CHARITY CARE POLICY WITH PATIENTS UPON ADMISSION. NOTICE IS ALSO INCLUDED IN PAYMENT REMINDER LETTERS. ST. MICHAEL'S HOSPITAL, INC. PART V, SECTION B, LINE 22D: LOOK BACK METHOD - IP/OP MEDICARE AND COMMERICAL OVERALL ADJUSTMENT RATE. 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, LIABILITIES, OUTSTANDING MEDICAL DEBTS, THE OVERALL DEBT TO ASSET RATIO FOR EACH SITUATION, 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. PART I, LINE 6A: SMH PREPARES A COMMUNITY BENEFIT REPORT THAT IS SUBMITTED TO AVERA HEALTH. THE INFORMATION IS MADE AVAILABLE TO THE PUBLIC THROUGH AVERA HEALTH'S COMMUNITY BENEFIT REPORT. 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, LN 7 COL(F): BAD DEBT EXPENSE OF $232,789 WAS SUBTRACTED FROM TOTAL OPERATING EXPENSE. 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. PART III, LINE 3: THE AMOUNT ON LINE 3 OF $81,476 IS 35% OF TOTAL BAD DEBT EXPENSE. THE NUMBER IS BASED ON A DETAILED REVIEW OF THE ACCOUNTS THAT ARE CURRENTLY LISTED WITH CREDIT COLLECTION BUREAU (CCB) AND ACCOUNTS MANAGEMENT INC. (AMI). UPON REVIEWING EACH ACCOUNT THAT IS AT CCB AND AMI, IT WAS FOUND THAT ABOUT 35% OF THE OUTSTANDING BALANCES MAY HAVE BEEN ELIGIBLE UNDER THE FACILITY'S CHARITY CARE POLICY. SINCE WE ARE A SMALL COMMUNITY, WE WERE ABLE TO IDENTIFY WHICH ACCOUNTS MAY HAVE QUALIFIED FOR CHARITY CARE BECAUSE OF LOW INCOME OR SOME KNOWN HARDSHIP TO THE HOUSEHOLD. ALSO FOR THIS REVIEW PROCESS, ANY FAMILIES WITH PRIOR APPLICATIONS FOR CHARITY CARE WERE GIVEN CONSIDERATION WHEN REVIEWING THE CCB AND AMI ACCOUNTS. PART III, LINE 4: THE FOOTNOTE THAT DESCRIBES BAD DEBT EXPENSE IS ON PAGE 6 NOTE 1 OF THE AUDITED FINANCIAL STATEMENT. PART III, LINE 8: MEDICARE ALLOWABLE COST OF CARE WAS CALCULATED FROM THE MEDICARE COST REPORT FOR THE FISCAL YEAR ENDING 6/30/2016.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: ST. MICHAEL'S HOSPITAL AVERA COLLECTED QUALITATIVE DATA THROUGH VARIOUS GROUP INTERVIEWS, IN PERSON ONE ON ONE INTERVIEWS AND TELEPHONE INTERVIEWS THAT WERE CONDUCTED FROM THE FALL OF 2015 THROUGH MARCH 2016. VARIOUS INDIVIDUALS AS WELL AS REPRESENTATIVES FROM BON HOMME AND AVON SCHOOLS, BON HOMME FOOD PANTRY, COUNTY HEALTH NURSE, THE LOCAL BARGAIN SHOP, CHAMBER OF COMMERCE, MIKE DURFEE STATE PRISON, EMS SERVICES, SPRINGFIELD COMMUNITY DOCTORS GROUP, TYNDALL ROTARY AND SENIOR CITIZENS GROUPS PROVIDED FEEDBACK IN ADDITION TO ST. MICHAEL'S BOARD OF DIRECTORS, DEPARTMENT MANAGERS AND MEDICAL STAFF.QUANTITATIVE DATA WAS GATHERED FROM THE U.S. CENSUS BUREAU AND THE SOUTH DAKOTA DEPARTMENT OF HEALTH, OFFICE OF HEALTH STATISTICS, U.S. BUREAU OF LABOR STATISTICS, AND SOUTH DAKOTA ASSOCIATION OF HEALTHCARE ORGANIZATIONS. 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 BY 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 2015 CENSUS FOR BON HOMME COUNTY REPORTED 6,985 PEOPLE WITH 14.6% OF THE POPULATION AT 100% POVERTY OR BELOW. 20.5% OF BON HOMME COUNTY'S POPULATION IS AGE 65 OR OLDER (COMPARED TO 15.7% 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 2,272 CLIENTS WERE SERVED DURING THE FISCAL YEAR ENDED 6/30/2016. 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 NURSING, PHYSICAL THERAPY, AND PHARMACY STUDENTS.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 6/30/2016, THERE WERE 579 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 VIDEOCONFERENCING 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. 93 PATIENTS BENEFITED FROM THE E-EMERGENCY SERVICES DURING FISCAL YEAR ENDED 6/30/2016. 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 SERVICES. THESE SERVICES INCLUDE AVERA E-ICU, 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 RESOURCE 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. X X X 0 0 0 0 0 0 0 0 0 CAROL DEURMIER CEO 146847 0 0 0 1936 0 6957 0 7293 0 163033 0 0 0 DR MELVIN WALLINGA FAMILY PRACTICE PHYSICIAN 178048 0 0 0 1218 0 7852 0 11508 0 198626 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 2 MARTY KOCH AND ERNIE BURES HAVE A BUSINESS RELATIONSHIP. 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 11 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.