2014-05-14T14:10:32-05:00 2013-06-30 450250958 EIDE BAILLY LLP 800 NICOLLET MALL STE 1300 MINNEAPOLIS MN 554027033 990 2012-07-01 460225483 SACRED HEART HEALTH SERVICES SACR 6056688000 501 SUMMIT STREET YANKTON SD 57078 PAMELA J REZAC 6056688000 2014-05-13 1 KIM HUNWARDSEN CPA P00484560 6122536500 2014-05-13 2012 2015-11-30 17:44:51Z AVERA SACRED HEART HOSPITAL PAMELA J REZAC 501 SUMMIT STREET YANKTON SD 57078 111563364 0 0928 X WWW.AVERASACREDHEART.COM X 1911 SD PROMOTION OF HEALTH 14 9 1296 350 -28522 -30022 1978184 2019750 104992659 102558568 4124658 6570874 -299709 -412272 110795792 110736920 80496 147429 0 0 55857500 55059477 0 0 135289 45475239 46722976 101413235 101929882 9382557 8807038 243651187 256656790 38657041 38162313 204994146 218494477 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. 1 0 83822191 147429 102558568 AVERA SACRED HEART HOSPITAL (SACRED HEART HEALTH SERVICES) LEADS DELIVERY OF HEALTHCARE TO ITS REGION THROUGH OVER 1,000 EMPLOYEES (AS WELL AS 63 PHYSICIANS ON ITS ACTIVE MEDICAL STAFF) WHO COORDINATE CARE TO DELIVER PATIENT CARE AS AN INTEGRATED UNIT. AVERA SACRED HEART AND ITS AFFILIATES (REFERRED TO COLLECTIVELY AS SACRED HEART HEALTH SERVICES) ALSO WORK SEAMLESSLY TO MEET THE NEEDS OF THE COMMUNITIES THEY SERVE IN SOUTHEAST SOUTH DAKOTA AND NORTHEAST NEBRASKA. IN ADDITION TO THE 144 BED HOSPITAL, AVERA SACRED HEART INCLUDES TWO NURSING HOMES AND A CONGREGATE HOUSING FACILITY, A 23-BED CRITICAL ACCESS HOSPITAL, LONG-TERM CARE FACILITY, AND 2 CLINICS IN CREIGHTON, NE. IT ALSO MANAGES THREE HOSPITALS AND TWO NURSING HOMES. AVERA SACRED HEART OPERATES UNDER THE TENETS OF THE ROMAN CATHOLIC CHURCH AND IN ACCORDANCE WITH THE PHILOSOPHY AND VALUES ESTABLISHED FOR AVERA HEALTH, A SPONSORED HEALTH MINISTRY OF THE BENEDICTINE AND PRESENTATION SISTERS. AVERA SACRED HEART ENGAGES IN ACTIVITIES DESIGNED TO IMPROVE THE HEALTH OF THE INDIVIDUALS AND COMMUNITIES THAT IT SERVES IN RESPONSE TO A CALLING TO HEAL THE SICK, THE ELDERLY AND THE OPPRESSED.REQUIREMENTS OF THE IRS COMMUNITY BENEFIT STANDARD FOR TAX-EXEMPT ORGANIZATIONS ARE INTEGRAL TO AVERA SACRED HEART HOSPITAL'S LARGER CHARITABLE MISSION OF IMPROVING HEALTH AND QUALITY OF LIFE. SPECIFICALLY, AVERA SACRED HEART IS GOVERNED BY AN INDEPENDENT BOARD INCLUDING COMMUNITY LEADERS, BUSINESS AND CLINICAL HEALTHCARE EXPERTS. THE BOARD HAS A HISTORY OF COMMITMENT TO ACT WITH THE HIGHEST INTEGRITY AND HAS BEEN PROACTIVELY EVALUATING OPPORTUNITIES TO VOLUNTARILY ADOPT GOVERNANCE BEST PRACTICES FOR THE BENEFIT OF THE COMMUNITY. * SACRED HEART HEALTH SERVICES MAKES MEDICAL CARE ACCESSIBLE TO THE COMMUNITIES IT SERVES REGARDLESS OF ABILITY TO PAY, OF WHICH THERE WERE 14,175 HOSPITAL PATIENT DAYS AND 83,279 NURSING HOME RESIDENT DAYS IN FISCAL YEAR 2013. AVERA SACRED HEART HOSPITAL WAS NAMED BY HEALTHGRADES AS ONE OF THE TOP 10% HOSPITALS IN THE NATION FOR PROVIDING AN OUTSTANDING PATIENT EXPERIENCE, SIX YEARS IN A ROW. THE HOSPITAL WAS A FIVE-STAR RECIPIENT FOR TREATMENT OF HEART ATTACK FOR 2 YEARS IN A ROW 2012-2013, AND A FIVE-STAR RECIPIENT FOR CAROTID SURGERY IN 2013. THEY WERE RANKED #2 IN SOUTH DAKOTA FOR TREATMENT OF STROKE IN 2013, RANKED #1 IN SOUTH DAKOTA FOR OVERALL PULMONARY SERVICES FOR 3 YEARS IN A ROW, RANKED #4 IN SOUTH DAKOTA FOR GENERAL SURGERY IN 2013, AND RANKED #4 IN SOUTH DAKOTA FOR GASTROINTESTINAL SERVICES IN 2013. THE HOSPITAL ALSO RECEIVED A PATIENT SAFETY EXCELLENCE AWARD FROM HEALTHGRADES.SACRED HEART HEALTH SERVICES OPERATES 2 FULL-TIME EMERGENCY DEPARTMENTS, ONE IN YANKTON AND ONE IN CREIGHTON, NEBRASKA, WHICH PROVIDE EMERGENCY CARE REGARDLESS OF ABILITY TO PAY. IN FISCAL YEAR 2013, THERE WERE 10,638 VISITS. AVERA SACRED HEART PROVIDES CLINICAL SERVICES NEEDED TO OPERATE THE EMERGENCY CENTER AND PROVIDES ON-SITE EMERGENCY MEDICAL, RESCUE AND MEDICAL TRANSPORTATION SERVICES. IN ADDITION, AVERA SACRED HEART, THROUGH ITS INTEGRATED NETWORK OF PROVIDERS, PROVIDES NON-EMERGENCY SERVICES TO THE COMMUNITY IT SERVES. IT MAKES THESE SERVICES ACCESSIBLE TO THE COMMUNITY THROUGH PARTICIPATION IN GOVERNMENT PROGRAMS LIKE MEDICARE AND MEDICAID, REGARDLESS OF ABILITY TO PAY. AVERA'S CHARITY CARE POLICY PROVIDES DISCOUNTED AND FREE SERVICES TO PATIENTS WHO LACK THE RESOURCES TO BE FULLY RESPONSIBLE FOR THE HEALTH CARE THEY RECEIVE. THE CHARITY CARE POLICY IS DESIGNED TO ENSURE THE COMMUNITIES SERVED BY AVERA FACILITIES HAVE ACCESS TO NEEDED HEALTHCARE SERVICES. THE AVERA SACRED HEART BOARD OF DIRECTORS OVERSEES SERVICES DELIVERED UNDER THE CHARITY CARE POLICY INCLUDING ASSESSING COMMUNITY NEEDS, APPROVING ELIGIBILITY CRITERIA AND MONITORING THE EFFECTIVENESS OF THE PROGRAM IN PROVIDING COMMUNITY ACCESS TO MEDICAL CARE.ELIGIBILITY FOR DISCOUNTED OR FREE SERVICES UNDER THE CHARITY CARE POLICY IS BASED ON INCOME LEVELS AND FAMILY SIZE. APPLICATIONS FOR COVERAGE UNDER THE PROGRAM MAY BE OBTAINED AT ANY AVERA SACRED HEART PATIENT REGISTRATION AREA OR BY CALLING THE AVERA SACRED HEART OR AVERA CREIGHTON BUSINESS OFFICE. SACRED HEART HEALTH SERVICES MAINTAINS RECORDS TO IDENTIFY AND MONITOR THE LEVEL OF CARE PROVIDED UNDER THE CHARITY CARE POLICY. SACRED HEART HEALTH SERVICES HAD CHARGES FORGONE FOR CHARITY FOR THE YEAR ENDED JUNE 30, 2013 OF APPROXIMATELY $2,364,000.SACRED HEART HEALTH SERVICES TAKES ITS MISSION TO IMPROVE THE HEALTH AND QUALITY OF LIFE OF THE PEOPLE IT SERVES A STEP FURTHER BY REACHING OUT TO MEET THE BROAD HEALTH NEEDS OF THE COMMUNITY. IT STRIVES TO IDENTIFY COMMUNITY NEEDS BEYOND BASIC HEALTH CARE, RESPOND TO THEM, AIMING TO MAKE A POSITIVE, LIFE-ENHANCING DIFFERENCE IN THE COMMUNITY. SACRED HEART HEALTH SERVICES TAKES A STRATEGIC, COMMUNITY NEEDS-BASED APPROACH TO DELIVERING BENEFITS TO THE COMMUNITY. AVERA SACRED HEART HOSPITAL DEMONSTRATES ITS COMMITMENT TO PROVIDING COMMUNITY BENEFIT THROUGH SPECIFIC ACCOMPLISHMENTS:E-TECHNOLOGY: AVERA SACRED HEART STARTED WITH ITS EICU PROGRAM SIX YEARS AGO. EICU IS A TELEMEDICINE-BASED SYSTEM THAT AIDS IN THE CARE OF ICU PATIENTS AT AVERA SACRED HEART AND ACROSS THE AVERA SYSTEM. PATIENTS RECEIVE CONSTANT, AROUND-THE-CLOCK MONITORING AND INTERVENTIONS FROM A REMOTE CARE TEAM IN ADDITION TO THE CARE THEY RECEIVE FROM THEIR BEDSIDE TEAM. IN ADDITION, AVERA SACRED HEART HOSPITAL, ALONG WITH ST. MICHAEL'S HOSPITAL/AVERA AND WAGNER COMMUNITY MEMORIAL HOSPITAL/AVERA, HAS LAUNCHED AN ESTROKE PROGRAM THAT WILL ENABLE PATIENTS SUFFERING STROKES TO BE MORE QUICKLY DIAGNOSED AND TREATED THROUGH THE USE OF TELEMEDICINE. AVERA HAS ALSO IMPLEMENTED AN E-PHARMACY PROGRAM WHERE FACILITIES WITHOUT 24 HOUR A DAY PHARMACIST COVERAGE CAN ACCESS PHARMACIST SERVICES REMOTELY.TEACHING HOSPITAL: AVERA SACRED HEART IS A TEACHING HOSPITAL, WHICH REFLECTS A STRONG COMMITMENT TO EDUCATION, RESEARCH AND A HIGH LEVEL OF CARE. IN THE SUMMER OF 2007, THE HOSPITAL OPENED THE NEW AVERA PROFESSIONAL OFFICE PAVILION & EDUCATION CENTER TO ENHANCE THEIR COMMITMENT TO MEDICAL EDUCATION. THE AVERA PAVILION IS THE NEW HOME OF THE UNIQUE YANKTON AMBULATORY PROGRAM FOR THE THIRD-YEAR MEDICAL STUDENTS OF THE SANFORD SCHOOL OF MEDICINE OF THE UNIVERSITY OF SOUTH DAKOTA. THE PROGRAM CHALLENGES MEDICAL STUDENTS TO SOLVE CLINICAL PROBLEMS AND EXPERIENCE THE DOCTOR-PATIENT RELATIONSHIP THROUGH THE YEAR. YANKTON IS ONLY ONE OF THREE COMMUNITIES IN THE STATE WHERE A CAMPUS IS PROVIDED FOR THE SANFORD SCHOOL OF MEDICINE. THE OFFICE FOR THE DEAN OF THE YANKTON AMBULATORY PROGRAM OF THE AVERA SACRED HEART YANKTON CAMPUS IS NOW LOCATED ON THE FIRST FLOOR OF THE PAVILION. STUDY SPACE FOR THE MEDICAL STUDENTS IS ADJACENT TO THE ASHH MEDICAL LIBRARY. A UNIQUE COMPONENT TO THE PAVILION IS THE EXPANSION AND ENHANCEMENT OF EDUCATIONAL FACILITIES. ALONG WITH A 116-SEAT AUDITORIUM, THERE ARE ALSO THREE CONFERENCE ROOMS, ALL EQUIPPED WITH THE LATEST IN AUDIOVISUAL TECHNOLOGY.(CONTINUED ON PAGE 8 OF SCHEDULE O) 83822191 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 1 0 0 1 0 1 0 0 0 0 1 1 1 0 0 1 182 0 1 1296 1 1 1 0 0 0 0 1 1 0 0 0 0 X 14 9 1 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 0 0 0 X JAMIE A SCHAEFER 6056688776 501 SUMMIT YANKTON SD 57078 ROB STEPHENSON 2.00 0.00 X X 0 0 0 MICHAEL PIETILA 2.00 0.00 X X 0 0 0 AMY FREEBURG 2.00 0.00 X 0 0 0 SR JEANNE ANNETTE WEBER 2.00 0.00 X 0 0 0 SR CORRINE LEMMER 2.00 0.00 X 0 0 0 BRAD DYKES 2.00 0.00 X 0 0 0 JOHN PORTER 2.00 0.00 X 0 1149458 49310 CHARLES CAMMOCK 2.00 0.00 X 0 0 0 MARTY JANS 2.00 0.00 X 0 0 0 SR LUCILLE WELBIG 2.00 5.00 X 0 0 0 SR LYNN MARIE WELBIG 2.00 0.00 X 0 0 0 WAYNE A KINDLE 2.00 0.00 X 0 0 0 RUSS DEIDRICHSEN 2.00 0.00 X 0 0 0 PAMELA J REZAC 60.00 2.50 X X 0 455478 51366 JAMIE A SCHAEFER 52.00 1.00 X 181673 0 17550 DOUGLAS EKEREN 52.00 2.50 X 194749 0 27419 MICHAEL PETERSON 40.00 0.00 X 472349 0 46251 GREGORY TAYLOR 40.00 0.00 X 500176 0 47204 STEVE GUTNIK 40.00 0.00 X 687113 0 28751 MATTHEW G WINKELBAUER 40.00 0.00 X 575690 0 993 TERENCE PEDERSON 40.00 0.00 X 303413 0 23720 BARBARA LARSON 0.00 52.00 X 0 141758 43672 2915163 1746694 336236 46 1 1 0 YANKTON ANESTHESIOLOGY PC 1000 W 4TH ST SUITE 13 YANKTON SD 57078 ANESTHESIOLOGISTS 1586060 YANKTON MEDICAL CLINIC PC PO BOX 706 YANKTON SD 57078 PHYSICIAN SERVICES 627268 C & A INDUSTRIES PO BOX 3037 OMAHA NE 68103 TEMP STAFFING 587417 BROWNS MEDICAL IMAGING 14315 C CIR OMAHA NE 68144 IMAGING 389413 ASSOCIATED REGIONAL & UNIVERSITY PO BOX 27964 SALT LAKE CITY UT 84127 LAB SERVICES 235896 13 71624 50000 1588067 310059 73786 2019750 NET PATIENT SERVICE REVENUE 622110 100109791 100109791 OTHER REVENUE 900099 1336731 1336731 NONMEDICAL OUTREACH 900099 1209937 1209937 INCOME FROM AFFILIATES 900099 7356 35878 -28522 INTEREST IN BENEDICTINE HEALTH FO 900099 -105247 -105247 102558568 1064985 1064985 135374 751506 -616132 -616132 -616132 5556355 0 50466 5556355 -50466 5505889 5505889 69617 71624 24472 45145 45145 INTEREST INCOME 900099 158715 158715 158715 110736920 102587090 -28522 6158602 X 127429 127429 20000 20000 481087 481087 87302 87302 44064767 38989973 4981259 93535 1053897 849958 200336 3603 6559995 5779483 766807 13705 2812429 2407348 399294 5787 22836 22836 7800 7800 14297542 5851888 8445654 550187 76974 461790 11423 5909117 4948771 957773 2573 218414 59121 159293 1870340 1868934 1406 471936 392524 78448 964 550739 178466 371455 818 322099 322099 6841865 6841865 931248 931248 MEDICAL SUPPLIES 9972446 9971661 785 BAD DEBT EXPENSE 3178159 3178159 EQUIPMENT LEASE AND REN 501078 355523 145555 LICENSES AND PERMITS 155718 115736 39982 921452 467729 450842 2881 101929882 83822191 17972402 135289 2031112 4870900 679 17826710 15048834 60417 35416 9991401 2258638 2353157 2019902 834949 1382969 152036033 86889582 57423943 65146451 9111837 6688499 141923137 156793713 952712 1258681 638945 637051 502188 515736 243651187 256656790 9764558 10769301 567529 490836 25787945 25217086 15312 18259 2521697 1666831 38657041 38162313 X 191500652 204444147 13035578 13592414 457916 457916 204994146 218494477 243651187 256656790 X 8807038 6000753 -1307460 X X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 13523 13523 0 EXPLANATION OF LOBBYING ACTIVITIES: PART II-B, LINE 1: SACRED HEART HEALTH SERVICES PAID DUES TO ORGANIZATIONS WHICH HAVE A PORTION OF THE DUES ATTRIBUTED TO LOBBYING ACTIVITIES. 0 1 X 793011 6400 58742 18788 839365 801064 5310 -480 12883 793011 716457 1120 87570 4083 801064 676350 540 41680 2113 716457 721018 11570 -18197 38041 676350 0.54560 0.45440 0 0 3538850 3538850 88838917 54091047 34747870 43560733 29312655 14248078 16097533 3485880 12611653 65146451 ASSETS LIMITED TO USE - AVERA POOLED INVESTMENTS 155836028 F INVESTMENT IN AFFILIATED ORGANIZATION 957685 C 156793713 ESTIMATED THIRD-PARTY PAYOR SETTLEMENTS 1180000 MARKET VALUE OF INTEREST RATE SWAP 486831 1666831 X 114122021 6000753 -1288321 4712432 109409589 1327331 1327331 110736920 100120771 1369048 1369048 98751723 3178159 3178159 101929882 PART IV, LINE 2B: RESIDENT TRUST FUNDS ARE HELD ON BEHALF OF THE RESIDENTS. DESCRIPTION OF INTENDED USE OF ENDOWMENT FUNDS: 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. DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X, LINE 2: THE ORGANIZATION 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). CERTAIN CONSOLIDATED SUBSIDIARIES, INCLUDING VALLEY HEALTH SERVICES, ARE NOT TAX-EXEMPT ENTITIES AND ARE CONSIDERED PARTNERSHIPS OR DISREGARDED ENTITIES FOR TAX PURPOSES. THE ORGANIZATION IS ANNUALLY REQUIRED TO FILE A RETURN OF ORGANIZATION EXEMPT FROM INCOME TAX (FORM 990) WITH THE IRS. IN ADDITION, THE ORGANIZATION IS SUBJECT TO INCOME TAX ON NET INCOME THAT IS DERIVED FROM BUSINESS ACTIVITIES THAT ARE UNRELATED TO ITS EXEMPT PURPOSE. THE ORGANIZATION FILES AN EXEMPT ORGANIZATION BUSINESS INCOME TAX RETURN (FORM 990T) WITH THE IRS TO REPORT ITS UNRELATED BUSINESS TAXABLE INCOME. THE ORGANIZATION 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 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. THE ORGANIZATION'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: ACCUMULATED LOSS INTEREST SWAP -22,247. LOSS ON REFINANCING 234,867. BAD DEBT EXPENSE REPORTED IN INCOME FOR FINANCIAL STATEMENT -3,178,159. RELATED ORGANIZATIONS' REVENUE INCLUDED IN CONSOLIDATED FINANCIAL STATEMENTS 1,677,218. PART XI, LINE 4B - OTHER ADJUSTMENTS: CONTRIBUTIONS REPORTED IN FUND BALANCE ON FINANCIAL STATEMENTS 295,840. INVESTMENT INCOME REPORTED IN FUND BALANCE ON FINANCIAL STATEMENTS 981,491. TRANSFER FROM RELATED ORGANIZATION ELIMINATED FOR F/S PURPOSES 50,000. PART XII, LINE 2D - OTHER ADJUSTMENTS: RELATED ORGANIZATIONS' EXPENSES INCLUDED IN CONSOLIDATED FINANCIAL STATEMENT 1,369,048. PART XII, LINE 4B - OTHER ADJUSTMENTS: BAD DEBT EXPENSE REPORTED IN INCOME FOR FINANCIAL STATEMENT 3,178,159. SIMPLY D'VINE 109391 71624 37767 1511 650 8267 ROSES JUST BECAUSE 31850 31850 14044 141241 71624 69617 1511 650 22311 24472 45145 1 1 X 1 X 1 X 1 1 0 1 1 1746 862412 862412 0.00870 4121 12310341 8342266 3968075 0.04010 1728 3932772 3123407 809365 0.00820 7595 17105525 11465673 5639852 0.05700 9 1408 4705907 4012100 693807 0.00700 3 163019 14585 148434 0.00150 1 55650 39476 16174 0.00020 1 54929 41500 13429 0.00010 3 584338 584338 0.00590 17 1408 5563843 4107661 1456182 0.01470 17 9003 22669368 15573334 7096034 0.07170 1 2971671 0 24740821 33587184 -8846363 X 1 1 2 1 AVERA SACRED HEART HOSPITAL

501 SUMMIT STREET YANKTON SD 57078

X X X 2 PROVIDER-BASED CLINICS 2 AVERA CREIGHTON HOSPITAL

1503 MAIN STREET CREIGHTON NE 68729

X X X X AVERA SACRED HEART HOSPITAL 1 1 X X X X X X X X 12 1 0 1 X X X X X 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 X 1 0 X X X X 1 X 0 1 AVERA CREIGHTON HOSPITAL 2 1 X X X X X X X X 12 1 1 1 X X X X 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 X 1 0 X X X X 1 X 0 1 6 AVERA YANKTON CARE CENTER

1212 W 8TH STREET YANKTON SD 57078

LONG TERM CARE AVERA SISTER JAMES CARE CENTER

2111 W 11TH STREET YANKTON SD 57078

LONG TERM CARE AVERA SACRED HEART MAJESTIC BLUFFS

2111 W 11TH STREET YANKTON SD 57078

ASSISTED LIVING AVERA SACRED HEART HOSPITAL-REHAB UNIT

501 SUMMIT STREET YANKTON SD 57078

REHAB UNIT AVERA CREIGHTON CARE CENTRE

1603 MAIN STREET CREIGHTON NE 687292999

LONG TERM CARE AVERA SACRED HEART HOSPITAL-DIALYSIS

501 SUMMIT STREET YANKTON SD 57078

DIALYSIS UNIT PART I, LINE 3C: A COMBINATION OF INCOME AND ASSETS TEST IS UTILIZED TO DETERMINE ELIGIBILITY FOR FREE OR DISCOUNTED CARE. POINTS ARE ASSIGNED BASED ON INCOME AS A PERCENTAGE OF FPG AND NET ASSETS OWNED WITH POINTS DEDUCTED FOR ONGOING MEDICAL EXPENSES SUCH AS DRUGS. PATIENTS WITH THE FEWEST POINTS RECEIVE THE LARGEST DISCOUNT. 0-1 POINTS RECEIVE 100% DISCOUNT ON BILLS WHILE REMAINING DISCOUNTS RANGE FROM 10-90% DEPENDING ON POINT TOTALS AND DOLLAR AMOUNT OF CHARGES. PART I, LINE 6A: PART 1, LINE 6A: OUR COMMUNITY BENEFIT REPORT IS CONTAINED IN A REPORT PREPARED BY AVERA HEALTH, A RELATED ORGANIZATION. IT IS AVAILABLE THROUGH THE WEBSITE AND REQUESTED MAILING, AND IS FILED WITH THE CATHOLIC HEALTH ASSOCIATION. PART I, LINE 7: CHARITY CARE, UNREIMBURSED MEDICAID, AND OTHER MEANS-TESTED GOVERNMENT PROGRAMS WERE CONVERTED TO COST USING THE COST TO CHARGE RATIO BASED ON PRIOR YEAR MEDICARE COST REPORT. UNREIMBURSED MEDICAID USES A COST TO CHARGE RATIO THAT INCLUDES OTHER ACTIVITIES BEYOND HOSPITAL INPATIENT. THE AMOUNTS ON LINES 7E-I REPRESENT EXPENSES REPORTED IN THE GENERAL LEDGER AND COMPILED USING CBISA SOFTWARE. PART I, L7 COL(F): BAD DEBT EXPENSE OF $2,971,671 IS INCLUDED ON FORM 990, PART IX, LINE 25, COLUMN (A) BUT EXCLUDED FOR PURPOSES OF CALCULATING THIS PERCENTAGE. PART III, LINE 4: BAD DEBT IS REPORTED AT CHARGES AS RECORDED BY THE ORGANIZATION. 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. SACRED HEART HEALTH SERVICES DOES NOT BELIEVE THAT ANY PORTION OF BAD DEBT EXPENSE COULD REASONABLY BE ATTRIBUTED TO PATIENTS WHO MAY QUALIFY FOR FINANCIAL ASSISTANCE SINCE EVALUATIONS ARE COMPLETED TO DETERMINE THOSE AMOUNTS DUE AND WILL BE RECLASSIFIED FROM BAD DEBT EXPENSE TO CHARITY CARE WITHIN 30 DAYS FOLLOWING THE EVALUATION OF THE AMOUNT. NOTE 1 ON PAGE 8 OF THE FINANCIAL STATEMENTS DESCRIBES BAD DEBT EXPENSE. 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, A HOME MEDICAL EQUIPMENT STORE, 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, A HOME MEDICAL EQUIPMENT STORE, 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 A REASONABLE TIME PERIOD, THE ORGANIZATION OR ITS AGENT SHALL NOT SEND, NOR INDICATE THAT IT WILL SEND, THE UNPAID BILL TO ANY OUTSIDE COLLECTION AGENCY. AT SUCH TIME AS THE ORGANIZATION SENDS THE UNCOLLECTED ACCOUNT TO AN OUTSIDE COLLECTION AGENCY, THE AMOUNT REFERRED TO THE AGENCY SHALL REFLECT THE REDUCED-PAYMENT LEVEL FOR WHICH THE PATIENT WAS ELIGIBLE UNDER THE ORGANIZATION'S FINANCIAL ASSISTANCE POLICY FOR LOW-INCOME UNINSURED PATIENTS. SACRED HEART HEALTH SERVICES DOES NOT REPORT ANY DATA TO ANY OF THE CREDIT AGENCIES, HOWEVER, THE COLLECTION AGENCIES SACRED HEART HEALTH SERVICES UTILIZES MAY REPORT TO THE CREDIT AGENCIES. ANY EXTENDED PAYMENT PLANS OFFERED BY THE HOSPITAL, OR THE HOSPITAL'S REPRESENTATIVE, IN SETTLING THE OUTSTANDING BILLS OF PATIENTS WHO QUALIFY FOR FINANCIAL ASSISTANCE SHALL BE INTEREST-FREE SO LONG AS THE REPAYMENT SCHEDULE IS MET. AVERA SACRED HEART HOSPITAL PART V, SECTION B, LINE 3: AVERA SACRED HEART HOSPITAL UTILIZED A CONSULTANT TO ASSIST WITH THE PROCESS OF CONDUCTING FOCUS GROUPS TO ENSURE PARTICIPANTS FELT AT EASE TO SHARE THEIR OPINIONS. ADDITIONAL FOCUS GROUPS AND INTERVIEWS WERE CONDUCTED BY HOSPITAL PERSONNEL IN COUNTIES OUTSIDE THE IMMEDIATE SERVICE AREA. PERSONAL INVITATIONS WERE SENT TO ORGANIZATIONS AND INDIVIDUALS REPRESENTING THE BROAD INTEREST OF THE COMMUNITIES, INCLUDING AREAS MOST IMPACTED BY HEALTH DISPARITIES. AVERA CREIGHTON HOSPITAL PART V, SECTION B, LINE 3: AVERA CREIGHTON HOSPITAL USED INTERVIEWS, SURVEYS, AND FOCUS GROUPS ENSURING THEY REACHED INDIVIDUALS WITH SPECIFIC KNOWLEDGE REGARDING INSURANCE ISSUES, HEALTH REFORM, MEDICAL SPECIALISTS, RURAL HEALTH ISSUES, POPULATION ISOLATION, JOB LOSS, WATER ISSUES, SKIN CANCER, AFFORDABLE HOUSING, AND ELDERLY. SPECIFIC TARGETED PARTICIPANTS INCLUDED REPRESENTATIVES OF NORTH CENTRAL DISTRICT HEALTH DEPARTMENT, NORTH CENTRAL COMMUNITY CARE PARTNERSHIP, REGION 4 BEHAVIORAL HEALTH SYSTEM, AND HEARTLAND COUNSELING. AVERA CREIGHTON HOSPITAL PART V, SECTION B, LINE 4: AVERA CREIGHTON HOSPITAL PARTNERED WITH THE TEN OTHER HOSPITALS IN THE NORTH CENTRAL DISTRICT HEALTH DEPARTMENT INCLUDING ANTELOPE MEMORIAL HOSPITAL, AVERA ST. ANTHONY'S HOSPITAL, OSMOND GENERAL HOSPITAL, PLAINVIEW COMMUNITY HOSPITAL, TILDEN COMMUNITY HOSPITAL, NIOBRARA VALLEY HOSPITAL, WEST HOLT MEMORIAL HOSPITAL, BROWN COUNTY HOSPITAL, CHERRY COUNTY HOSPITAL, AND ROCK COUNTY HOSPITAL IN CONDUCTING THE COMMUNITY HEALTH NEEDS ASSESSMENT. AVERA SACRED HEART HOSPITAL PART V, SECTION B, LINE 5C: THE CHNA IS AVAILABLE AT THE FOLLOWING WEBSITE: HTTP://WWW.AVERA.ORG/EXPERIENCE/SHARED/COMMUNITY-NEEDS-HEALTH-ASSESSMENTS/. AVERA CREIGHTON HOSPITAL PART V, SECTION B, LINE 5C: THE CHNA IS AVAILABLE AT THE FOLLOWING WEBSITE: HTTP://WWW.AVERA.ORG/EXPERIENCE/SHARED/COMMUNITY-NEEDS-HEALTH-ASSESSMENTS/. AVERA SACRED HEART HOSPITAL PART V, SECTION B, LINE 6I: THE IMPLEMENTATION STRATEGY IS AVAILABLE AT THE FOLLOWING WEBSITE: HTTP://WWW.AVERA.ORG/EXPERIENCE/SHARED/COMMUNITY-NEEDS-HEALTH-ASSESSMENTS/. AVERA CREIGHTON HOSPITAL PART V, SECTION B, LINE 6I: THE IMPLEMENTATION STRATEGY IS AVAILABLE AT THE FOLLOWING WEBSITE: HTTP://WWW.AVERA.ORG/EXPERIENCE/SHARED/COMMUNITY-NEEDS-HEALTH-ASSESSMENTS/. AVERA SACRED HEART HOSPITAL PART V, SECTION B, LINE 14G: A SUMMARY OF THE FINANCIAL ASSISTANCE POLICY IS PROVIDED ON THE BILLING INVOICES, IN THE EMERGENCY ROOM, WAITING ROOMS, IN THE ADMISSIONS OFFICE, AND TO PATIENTS UPON ADMISSION. AVERA CREIGHTON HOSPITAL PART V, SECTION B, LINE 14G: A SUMMARY OF THE FINANCIAL ASSISTANCE POLICY IS PROVIDED ON THE BILLING INVOICES, IN THE EMERGENCY ROOM, WAITING ROOMS, IN THE ADMISSIONS OFFICE, AND TO PATIENTS UPON ADMISSION. AVERA SACRED HEART HOSPITAL PART V, SECTION B, LINE 22: INDIVIDUALS ELIGIBLE FOR FINANCIAL ASSISTANCE ARE NOT CHARGED GROSS CHARGES FOR EMERGENCY OR OTHER MEDICALLY NECESSARY CARE; HOWEVER MAY BE CHARGED GROSS CHARGES FOR ELECTIVE CARE. AVERA CREIGHTON HOSPITAL PART V, SECTION B, LINE 22: INDIVIDUALS ELIGIBLE FOR FINANCIAL ASSISTANCE ARE NOT CHARGED GROSS CHARGES FOR EMERGENCY OR OTHER MEDICALLY NECESSARY CARE; HOWEVER MAY BE CHARGED GROSS CHARGES FOR ELECTIVE CARE. 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 BILLS" 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 12% OF THE CITY OF YANKTON'S INDIVIDUAL RESIDENTS FALL BELOW THE FEDERAL POVERTY GUIDELINES. FOR FISCAL YEAR 2013, 47.5% OF OUR REVENUE CAME FROM MEDICARE AND MEDICARE ADVANTAGE PLANS, AND 12.1% 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, DESIGNATED REHABILITATION UNIT, 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 RADIATION 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 350 INDIVIDUALS CHOSE TO VOLUNTEER AT THE FACILITY DURING FISCAL YEAR 2013. 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 AVERA HEALTH 3900 W AVERA DRIVE SIOUX FALLS SD 57108 460422673 501(C)(3) 21000 USD SCHOLARSHIP FUND AVERA ST ANTHONY HOSPITAL FOUNDATION 300 N 2ND ST ONEILL NE 68763 470463911 501(C)(3) 20000 BUILDING PROJECT UNIVERSITY OF SOUTH DAKOTA PO BOX 5555 VERMILLION SD 57069 466000364 STATE OF SD 50000 OUTCOMES RESEARCH UNITED WAY OF YANKTON 610 W 23RD YANKTON SD 57078 460252854 501(C)(3) 12000 SUPPORT 4 0 SCHOLARSHIPS 4 20000 PROCEDURE FOR MONITORING GRANTS IN THE U.S.: PART I, LINE 2: SCHEDULE I, PART I, LINE 2: THE ORGANIZATION ONLY MAKES GRANTS TO OTHER ORGANIZATIONS WHICH ARE ALSO TAX-EXEMPT. IN FISCAL YEAR 2013, 4 MEDICAL SCHOOL STUDENTS WERE CHOSEN FOR $5,000 SCHOLARSHIPS. 0 0 0 0 0 0 0 0 0 JOHN PORTER 0 901311 0 500 0 247647 0 31098 0 19361 0 1199917 0 0 PAMELA J REZAC 0 369570 0 0 0 85908 0 30475 0 21739 0 507692 0 0 JAMIE A SCHAEFER 155858 0 7434 0 18381 0 0 0 17550 0 199223 0 0 0 DOUGLAS EKEREN 166698 0 8162 0 19889 0 0 0 27419 0 222168 0 0 0 MICHAEL PETERSON 436353 0 0 0 35996 0 0 0 46251 0 518600 0 0 0 GREGORY TAYLOR 452804 0 0 0 47372 0 0 0 47204 0 547380 0 0 0 STEVE GUTNIK 591795 0 0 0 95318 0 0 0 28751 0 715864 0 0 0 MATTHEW G WINKELBAUER 420291 0 127117 0 28282 0 0 0 993 0 576683 0 0 0 TERENCE PEDERSON 224954 0 57858 0 20601 0 0 0 23720 0 327133 0 0 0 BARBARA LARSON 0 114129 0 6687 0 20942 0 0 0 43671 0 185429 0 0 SUPPLEMENTAL INFORMATION PART III SCHEDULE J, PART I LINE 3: THE PRESIDENT & CEO'S COMPENSATION IS PAID BY A RELATED ORGANIZATION, AVERA HEALTH. AVERA SACRED HEART RELIED ON THE RELATED ORGANIZATION FOR DETERMINING THE COMPENSATION FOR THE PRESIDENT & CEO USING THE METHODS DESCRIBED IN PART I, LINE 3. GREGORY TAYLOR EMPLOYEE PHYSICIAN COMMUNITY NEEDS X 100000 35416 0 0 1 35416 JANET JANS SPOUSE OF BOARD MEMBER 59913 EMPLOYEE COMPENSATION 0 ALLISON DIEDRICHSEN SPOUSE OF BOARD MEMBER 27389 EMPLOYEE COMPENSATION 0 YANKTON MEDICAL CLINIC PARTNER OF YANKTON MEDICAL CLINIC IS BOARD MEMBER OF ORGANIZATION 627268 PROFESSIONAL SERVICES 0 X 58359 FMV X 37 15427 FMV 0 0 1 0 NEW PROGRAM SERVICES FORM 990, PART III, LINE 2 THE LATEST TECHNOLOGY IN CANCER RADIATION TREATMENT IS NOW AVAILABLE IN YANKTON AT THE AVERA SACRED HEART CANCER CENTER WITH THE ADDITION OF THE VARIAN IX LINEAR ACCELERATOR. THE DEVICE WILL PROVIDE FAR MORE ACCURACY IN RADIATION THERAPY, AND WILL WORK MUCH FASTER THAN CURRENT EQUIPMENT AND BECAME OPERATIONAL IN MARCH OF 2013. FORM 990, PART VI, SECTION A, LINE 2 JOHN PORTER, SR. LUCILLE WELBIG AND PAMELA J. REZAC 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 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. AVERA HEALTH 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 FORM 990, PART VI, SECTION B, LINE 11 THE FORM 990 IS REVIEWED INITIALLY BY THE CEO AND CFO. THE RETURN IS MADE AVAILABLE TO THE BOARD OF DIRECTORS FOR REVIEW PRIOR TO FILING. 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. THE CEO IS 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. THE COMPENSATION OF OTHER OFFICERS, DIRECTORS, AND KEY EMPLOYEES IS REVIEWED ANNUALLY. THE ORGANIZATION UTILIZES THE RESOURCES OF AN OUTSIDE INDEPENDENT AGENCY FOR MARKET COMPARABILITY. THE COMPENSATION IS APPROVED WITHIN THE ANNUAL BUDGET APPROVED BY THE BOARD. 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. OTHER FEES FORM 990, PART IX, LINE 11G REPAIRS AND MAINTENANCE: PROGRAM SERVICE EXPENSES 1,693,513. MANAGEMENT AND GENERAL EXPENSES 263,061. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,956,574. CONSULTING: PROGRAM SERVICE EXPENSES 799,289. MANAGEMENT AND GENERAL EXPENSES 168,279. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 967,568. PROFESSIONAL MEDICAL SERVICES: PROGRAM SERVICE EXPENSES 3,359,086. MANAGEMENT AND GENERAL EXPENSES 3,358,341. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 6,717,427. ACS FEES: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 4,655,973. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 4,655,973. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 9: CAPITAL TRANSFERS, NET -2,585,975. NET ASSETS RELEASED FROM DONOR RESTRICTION -363,034. CHANGE IN FAIR VALUE OF INTEREST RATE SWAP 234,867. TRANSFER FROM RELATED ORGANIZATION ELIMINATED FOR F/S PURPOSES -50,000. TRANSFER OF ASSETS FROM HEALTH MANAGEMENT SERVICES 1,376,684. OTHER ADJUSTMENTS 79,998. FORM 990, PART XII, LINE 2C: THE AUDIT COMMITTEE OF AVERA HEALTH, PARENT ORGANIZATION, SELECTS THE AUDITOR AND REVIEWS THE AUDITED FINANCIAL STATEMENTS FOR SACRED HEART HEALTH SERVICES. PART III, LINE 4A: (CONTINUED FROM PAGE 4 OF SCHEDULE O) RESIDENCY/HEALTH PROFESSIONS TRAINING: AT ANY ONE TIME, 10 TO 15 SANFORD SCHOOL OF MEDICINE OF THE UNIVERSITY OF SOUTH DAKOTA MEDICAL STUDENTS ARE IN TRAINING AT AVERA SACRED HEART HOSPITAL. IN ADDITION, STUDENTS IN NURSING, PHARMACY, PHYSICIAN ASSISTANT PROGRAMS, RADIOLOGY AND RESPIRATORY THERAPY ALSO AFFILIATE HERE. AVERA SACRED HEART ALSO HAS A RADIOLOGY TECHNOLOGIST SCHOOL, WHICH GRADUATES 6 TO 8 NEW RADIOLOGY TECHNOLOGISTS EACH YEAR. PREVENTIVE CARE A PRIORITY: AVERA SACRED HEART HAS TAKEN STEPS TO ENHANCE PREVENTIVE CARE FOR PEOPLE OF ALL AGES THROUGH THE MANY EDUCATIONAL PROGRAMS, HEALTH SCREENINGS AND FAIRS THAT ARE HELD THROUGHOUT THE YEAR. AVERA SACRED HEART HOLDS SCREENINGS THROUGHOUT THE REGION AT THEIR RURAL HEALTH CLINICS AS WELL AS IN YANKTON. THE HOSPITAL IS NOW CONNECTED TO THE ASK-A-NURSE PROGRAM THAT PROVIDES GENERAL INFORMATION CONCERNING HEALTH-RELATED TOPICS. OUR WEB SITE INCORPORATES THE "ADAM" SOFTWARE THAT PROVIDES A UNIQUE LEVEL OF HEALTH-RELATED INFORMATION TO THE CONSUMER. IN 2009, AVERA SACRED HEART HOSPITAL INTRODUCED PLANET HEART (IN CONJUNCTION WITH THE AVERA HEART HOSPITAL) AND AN IN-HOUSE CARDIOVASCULAR SCREENING PACKAGE TO KEEP THE PEOPLE WE SERVED BETTER INFORMED ABOUT THEIR HEALTH. BASED ON COMMUNITY NEEDS, WE ARE CONTINUALLY STRIVING TO PROVIDE MORE PREVENTATIVE TOOLS AND RISK ASSESSMENTS TO OUR POPULATION. COMMUNITY EDUCATION: AVERA SACRED HEART REACHES OUT TO PEOPLE AND COMMUNITIES THROUGHOUT SOUTHEASTERN SOUTH DAKOTA AND NORTHEASTERN NEBRASKA IN A VARIETY OF WAYS. FOR THE PAST FIVE YEARS, AVERA SACRED HEART HAS PARTNERED WITH HYVEE FOODS OF YANKTON AND THE YANKTON PUBLIC SCHOOL SYSTEM TO PROMOTE BETTER EATING HABITS FOR STUDENTS AND CENTERED ON THE "MY PLATE" CONCEPT. COMMUNITY FLU SHOT CLINICS ARE GENERALLY HELD THROUGHOUT THE REGION. THROUGH WELL COORDINATED EFFORTS STATEWIDE WITH OTHER HOSPITALS AND STATE ENTITIES, AVERA SACRED HEART WAS ABLE TO EFFECTIVELY DISTRIBUTE THE VACCINE DOSES IT RECEIVED IN A TIMELY AND EFFICIENT MANNER. WE ARE PROUD OF OUR CONTINUING 'TO BE WELL' HEALTH CARE EDUCATIONAL SERIES THAT PROVIDES EDUCATION TO THE COMMUNITY ON A VARIETY OF DISEASES AND CHRONIC CONDITIONS. EDUCATIONAL SESSIONS ARE OFFERED TO MEDICAL STAFF, STUDENTS, EMPLOYEES, HEALTH CARE PROFESSIONALS, STUDENTS OF ALL LEVELS AND THE GENERAL PUBLIC. UTILIZING THE AVERA PROFESSIONAL OFFICE PAVILION AND EDUCATION CENTER, HUNDREDS OF CLASSES INVOLVING THOUSANDS OF PEOPLE ARE PROVIDED AS A COMMUNITY SERVICE EACH YEAR. OTHER EXAMPLES OF COMMUNITY EDUCATION INCLUDE OUR STUDENT/YOUTH MENTORING PROGRAMS AND PARISH NURSING. PARTNERSHIPS WITH SCHOOLS, CHURCHES, BUSINESSES AND OTHER ORGANIZATIONS MAKE MANY OF THESE PROGRAMS POSSIBLE. AS AN INTEGRATED ORGANIZATION, AVERA AND AVERA SACRED HEART ARE LEADERS IN THE IMPLEMENTATION OF THE ELECTRONIC PATIENT RECORD (EMR). IN FISCAL YEAR 2013, SEVERAL NEW CLINICS WERE ADDED TO THE ASHH ELECTRONIC MEDICAL RECORD SYSTEM AS THE NATION MOVES TOWARD MORE INTEGRATED MEDICINE. COMMITMENT TO QUALITY: AVERA SACRED HEART IS ACCREDITED BY THE JOINT COMMISSION AND JUST RECEIVED ANOTHER THREE-YEAR ACCREDITATION IN 2011. 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, 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). 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. 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