2014-05-13T10:30:48-05:00 2013-06-30 450250958 EIDE BAILLY LLP 200 EAST 10TH ST PO BOX 5125 SIOUX FALLS SD 571175125 990 2012-07-01 460225414 ST MICHAEL'S HOSPITAL INC STMI 6055893341 410 WEST 16TH AVENUE TYNDALL SD 570662318 CAROL DEURMIER 6055893341 2014-05-05 1 LAURIE HANSON P00851848 6053391999 2014-05-05 2012 2015-11-30 17:44:51Z CAROL DEURMIER 410 WEST 16TH AVENUE TYNDALL SD 570662318 8784395 0 0928 X WWW.AVERA.ORG/ASH/STMICHAELS X 1966 SD TO PROVIDE HEALTHCARE SERVICES. 7 7 98 61 177738 0 55105 166723 8503622 8532484 61337 77937 -2926 -7230 8617138 8769914 0 2552 0 0 3984020 3815553 0 20538 20538 4195902 4221180 8179922 8059823 437216 710091 8178739 8964532 1343319 1341956 6835420 7622576 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 7115654 8525254 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, 2013, PATIENT DAYS WERE 474 AND SWING-BED DAYS WERE 2,099. 7115654 1 1 0 0 0 0 0 0 0 1 1 1 0 0 0 1 1 0 0 0 0 0 0 1 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 20 0 1 98 1 1 1 0 0 0 0 0 0 0 0 0 X 7 7 0 1 0 0 0 0 0 1 0 0 0 1 1 1 1 1 1 1 1 0 X LISA RONKE 6055893341 410 W 16TH AVE TYNDALL SD 570662318 RUSSELL BECHTOLD 1.00 X X 0 0 0 JOE KOSTAL 1.00 X X 0 0 0 JIM STOEBNER 1.00 X X 0 0 0 STEVE JOHNSON 1.00 X X 0 0 0 MARLENE ZIESER-BLACKBURN 1.00 X X 0 0 0 SISTER PAULETTE LARSEN 1.00 X 0 0 0 MARTY KOCH 1.00 X 0 0 0 DON IRISH 1.00 X 0 0 0 FATHER JOE FORCELLE 1.00 X 0 0 0 CAROL DEURMIER 50.00 X 123929 0 25794 LISA RONKE 40.00 X 39898 0 8727 DR MELVIN WALLINGA 40.00 X 163802 0 21125 DR JILL KRUSE 40.00 X 172616 0 21502 JACLYN DVORACEK 36.00 X 106995 0 12710 607240 0 89858 4 0 1 1 AVERA SACRED HEART HOSPITAL 501 SUMMIT YANKTON SD 57078 MANAGEMENT, OCCUPATIONAL&SPEECH THERAPY, 579892 1 53743 112980 166723 PATIENT SERVICE FEES 621110 6398391 6398391 RETAIL PHARMACY 446110 2083263 1905525 177738 MISCELLANEOUS 900099 50830 50830 8532484 77937 77937 7251 14481 -7230 -7230 -7230 8769914 8354746 177738 70707 2552 2552 205607 205607 3016213 2764834 251379 108431 99333 9098 269641 247004 22637 215661 194187 21474 126535 126535 31800 31800 20538 20538 175639 167543 8096 7079 1286 5793 139351 76733 62618 115831 115831 110803 110803 13623 8393 5230 3854 3464 390 40298 40298 533375 533375 69888 69888 SUPPLIES 2433681 2433681 EQUIPMENT AND MAINTENAN 247307 204898 42409 BAD DEBT 114859 114859 DUES AND SUBSCRIPTIONS 27676 13254 14422 29581 29269 312 8059823 7115654 923631 20538 1749703 2427971 810451 854189 379189 362297 56129 62174 7527983 4524404 3074935 3003579 833858 875933 1252809 1359581 21665 18808 8178739 8964532 560561 560017 11822 95266 770936 686673 1343319 1341956 X 6803783 7589816 11739 12617 19898 20143 6835420 7622576 8178739 8964532 710091 77065 0 X 0 1 X 0 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 19898 245 20143 19638 260 19898 19378 260 19638 19138 240 19378 18878 260 19138 1.00000 0 0 84849 84849 3534590 1990829 1543761 3808017 2471145 1336872 100527 62430 38097 3003579 INTEREST IN AVERA POOLED INVESTMENT FUNDS 1359581 F 1359581 X 8732120 77065 -114859 -37794 8769914 0 8769914 7944964 0 7944964 114859 114859 8059823 DESCRIPTION OF INTENDED USE OF ENDOWMENT FUNDS: PART V, LINE 4: THE INTENDED USE OF THE ORGANIZATION'S ENDOWMENT FUNDS IS TO PROVIDE FOR CAPITAL NEEDS THAT MAY ARISE. DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X, LINE 2: THE HOSPITAL BELIEVES THAT IT HAS APPROPRIATE SUPPORT FOR ANY TAX POSITIONS TAKEN AFFECTING ITS ANNUAL FILING REQUIREMENTS, AND AS SUCH, DOES NOT HAVE ANY UNCERTAIN TAX POSITIONS THAT ARE MATERIAL TO THE FINANCIAL STATEMENTS. THE HOSPITAL WOULD RECOGNIZE FUTURE ACCRUED INTEREST AND PENALTIES RELATED TO UNRECOGNIZED TAX BENEFITS AND LIABILITIES IN INCOME TAX EXPENSE IF SUCH INTEREST AND PENALTIES ARE INCURRED. THE HOSPITAL'S FEDERAL FORM 990T FILINGS ARE NO LONGER SUBJECT TO FEDERAL TAX EXAMINATIONS BY TAX AUTHORITIES FOR YEARS BEFORE 2010. PART XI, LINE 2D - OTHER ADJUSTMENTS: BAD DEBT EXPENSE -114,859. PART XII, LINE 4B - OTHER ADJUSTMENTS: BAD DEBT EXPENSE 114,859. 1 SHERWOOD CONSULTING SERVICE INC 4529 SHORELINE DRIVE 5 FORT COLLINS CO 80526 CONSULTING FOR FEASIBILITY STUDY & CAPITAL CAMPAIGN 0 0 20538 0 20538 SD MN NE ND IA 1 1 X 1 X 1 X 1 0 1 1 38000 38000 0.00470 241444 187157 54287 0.00670 279444 187157 92287 0.01140 132945 5218 127727 0.01580 45609 934 44675 0.00550 1286602 749208 537394 0.06670 8906 8906 0.00110 1474062 755360 718702 0.08910 1753506 942517 810989 0.10050 571 571 0.00010 2215 2215 0.00030 2786 2786 0.00040 0 114859 41349 2990964 2961351 29613 X 1 1 1 1 ST MICHAEL'S HOSPITAL INC

410 WEST 16TH AVENUE TYNDALL SD 570660027

HTTP://WWW1.AVERA.ORG/ASH/STMICHAELS/ X X X X ST MICHAEL'S HOSPITAL INC 1 1 X X X X X X X X 12 1 0 1 X X X X X X X 1 0 1 1 150.000000000000 1 400.000000000000 1 X X X X X X X 1 1 X X 1 0 X X 1 X 0 0 3 ST MICHAELS HOSPITAL INC

410 WEST 16TH AVENUE TYNDALL SD 57066

WELLNESS CENTER BON HOMME FAMILY PRACTICE CLINIC

130 MAIN STREET AVON SD 57315

FAMILY PRACTICE CLINIC BON HOMME FAMILY PRACTICE CLINIC

410 WEST 16TH AVENUE TYNDALL SD 57066

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. LINES 7E, 7F, AND 7I WERE OBTAINED UTILIZING THE ACTUAL GENERAL LEDGER SYSTEM. LINES 7B AND 7G WERE OBTAINED FROM THE MEDICARE COST REPORT. PART I, L7 COL(F): BAD DEBT EXPENSE OF $114,859 WAS SUBTRACTED FROM TOTAL OPERATING EXPENSE. PART II: 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 4: A) THE AMOUNT ON LINE 3 OF $41,349 IS 36% OF TOTAL BAD DEBT EXPENSE. THE NUMBER IS BASED ON A DETAILED REVIEW OF THE ACCOUNTS THAT ARE CURRENTLY LISTED WITH CREDIT COLLECTION BUREAU AND ACCOUNTS MANAGEMENT. UPON REVIEWING EACH ACCOUNT THAT IS AT CCB AND AMI, IT WAS FOUND THAT ABOUT 36% 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. B) 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.C) 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 6/30/2013. 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. ST. MICHAEL'S HOSPITAL, INC. PART V, SECTION B, LINE 3: THE HOSPITAL CONSULTED WITH COUNTY COMMUNITY HEALTH SERVICES, NURSES, MEDICAL PROVIDERS, SCHOOL OFFICIALS, BUSINESSLEADERS, RELIGIOUS LEADERS AND COMMUNITY MEMBERS. ST. MICHAEL'S HOSPITAL, INC. PART V, SECTION B, LINE 5C: THE CHNA IS AVAILABLE AT HTTP://WWW.AVERA.ORG/EXPERIENCE/SHARED/COMMUNITY-NEEDS-HEALTH-ASSESSMENTS/ ST. MICHAEL'S HOSPITAL, INC. PART V, SECTION B, LINE 6I: PART V, LINE 6A: THE IMPLEMENTATION STRATEGY IS AVAILABLE AT PAGE 15 OF THE COMMUNITY HEALTH NEEDS ASSESSMENT AT THE LINK LISTED ABOVE. ST. MICHAEL'S HOSPITAL, INC. PART V, SECTION B, LINE 7: PURSUANT TO THE IMPLEMENTATION STRATEGY ADOPTED BY ST MICHAEL'S HOSPITAL, INC., ALL NEEDS IDENTIFIED IN THE COMMUNITY HEALTH NEEDS ASSESSMENT WILL BE ADDRESSED. DURING THE CURRENT YEAR, NUTRITIONAL EDUCATION WAS NOT ADDRESSED DUE TO A TIME RESTRAINT. THERE WAS, HOWEVER, A PRELIMINARY DISCUSSION WITH SCHOOL ADMINSISTRATION REGARDING NUTRITIONAL EDUCATION. AS A RESULT OF THE NEEDS ASSESSMENT, A FEASIBILITY STUDY WAS DONE TO ADDRESS THE NEED FOR UPDATES TO THE MEDICAL FACILITY. THE FEASIBILITY STUDY FINDINGS WERE PRESENTED TO THE BOARD AND IT WAS DECIDED TO GO AHEAD WITH A CAPITAL CAMPAIGN, WHICH IS CURRENTLY IN PROCESS. ADDITIONALLY, BEHAVIORAL HEALTH RESOURCES HAVE ALREADY BEEN MET THROUGH PREVIOUS ACTIONS. ST. MICHAEL'S HOSPITAL, INC. PART V, SECTION B, LINE 14G: STAFF DISCUSS THE AVAILABILITY OF ITS CHARITY CARE POLICY WITH PATIENTS UPON ADMISSION. NOTICE IS ALSO INCLUDED IN PAYMENT REMINDER LETTERS. PART VI, LINE 2: ST. MICHAEL'S HOSPITAL AVERA PARTICIPATED IN AN EDUCATIONAL AND PLANNING SESSION CONDUCTED BY AVERA HEALTH. FROM THAT MEETING, THE ORGANIZATION ESTABLISHED A COMMUNITY HEALTH NEEDS ASSESSMENT COMMITTEE THAT INCLUDED ST. MICHAEL'S CHIEF EXECUTIVE OFFICER, THE DIRECTOR OF COMMUNITY AND EMPLOYEE RELATIONS, THE CHIEF FINANCIAL OFFICER AND THE DIRECTOR OF PATIENT SERVICES.ONE-ON-ONE INTERVIEWS AND WRITTEN QUESTIONNAIRES WITH REPRESENTATIVES FROM WITHIN OUR SERVICE AREA WERE CONDUCTED. THOSE INTERVIEWED INCLUDED SCHOOL OFFICIALS FROM BON HOMME AND AVON SCHOOLS, BUSINESS LEADERS FROM TYNDALL AND AVON, CITY OFFICIALS FROM TYNDALL AND AVON, BON HOMME COUNTY COMMUNITY HEALTH SERVICES, NURSES, MEDICAL PROVIDERS, THE BON HOMME COUNTY COMMUNITY HEALTH NURSE, AND MEMBERS OF THE ST. MICHAEL'S HOSPITAL BOARD OF DIRECTORS. THE MOST RECENT STATISTICS ABOUT PUBLIC HEALTH FROM COUNTY, STATE, AND NATIONAL SOURCES COLLECTED FROM THE US DEPT. OF HUMAN SERVICES, US CENTERS FOR DISEASE CONTROL, AND THE US CENSUS BUREAU WERE USED. IN ADDITION, SOUTH DAKOTA DEPARTMENT OF HEALTH STATISTICS WERE REVIEWED REGARDING THE HEALTH STATUS AND LEADING HEALTH INDICATORS FOR BON HOMME COUNTY. 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 2012 CENSUS FOR BON HOMME COUNTY REPORTED 7,029 PEOPLE WITH 12.2% OF THE POPULATION AT 100% POVERTY ORBELOW. 19.6% OF BON HOMME COUNTY'S POPULATION IS AGE 65 OR OLDER (COMPARED TO 14.7% IN THE STATE OF SOUTH DAKOTA). PART VI, LINE 5: THE MAJORITY OF 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, DIABETES 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 1,810 CLIENTS WERE SERVED DURING THE FISCAL YEAR ENDED 6/30/2013. 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, PHARMACY, XRAY, AND NURSE PRACTITIONER 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 6/30/2013, THERE WERE 639 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. 85 PATIENTS BENEFITED FROM THE E-EMERGENCY SERVICES DURING FISCAL YEAR ENDED 6/30/2013. 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 0 0 0 0 0 0 0 0 0 CAROL DEURMIER 122924 0 0 0 1005 0 5604 0 20190 0 149723 0 0 0 DR MELVIN WALLINGA 156922 0 6106 0 774 0 6915 0 14210 0 184927 0 0 0 DR JILL KRUSE 167849 0 4606 0 161 0 7292 0 14210 0 194118 0 0 0 SUPPLEMENTAL INFORMATION PART III FORM 990, PART VII, SECTION A, LINE 5 & FORM 990, SCHEDULE J, PART II: CAROL DEURMIER, CEO, IS COMPENSATED BY AVERA SACRED HEART HOSPITAL, 501 SUMMIT, YANKTON, SD 57078. FORM 990, PART VI, SECTION A, LINE 3 ST. MICHAEL'S HOSPITAL CEO IS IN A HEALTH MANAGEMENT AGREEMENT WITH AVERA SACRED HEART HOSPITAL. 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 COMPENSATION FOR THE CEO IS DETERMINED BY SMH'S BOARD OF DIRECTORS. THIS COMPENSATION PROCESS INCLUDES AN ANNUAL PERFORMANCE REVIEW AND COMPARABILITY DATA. 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 DOCUMENTS ARE NOT AVAILABLE TO THE PUBLIC.