4A (Expenses $ 125885423 including grants of $ 44736) (Revenue $ 143489672)
Avera Sacred Heart's mission is to provide healthcare services to Yankton, South Dakota residents and residents of the surrounding area. Avera Sacred Heart is a 501(c)(3) organization affiliated with Avera Health. Avera Sacred Heart consists of a 99-bed hospital and a 187-bed nursing home, congregate housing facility and a hospice house in Yankton, SD, a 23-bed critical access hospital and a 47-bed nursing home in Creighton, NE, and 14 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. Following is a breakdown of these statistics by facility:Avera Sacred Heart Hospital2,813 Acute inpatient discharges538 Newborn patient discharges51 Swing bed patient discharges94,449 Outpatient visits292 Swing-bed patient days1,322 Newborn patient days35,008 Clinic visitsAvera Sacred Heart Majestic Bluffs337 Long term care patient discharges60,768 Long-term care resident daysAvera Creighton Hospital (CAH)127 Acute inpatient discharges76 Swing bed patient discharges16,961 Outpatient visits683 Swing-bed patient days18,999 Clinic visitsAvera Creighton Care Centre22 Long term care patient discharges13,802 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 $1,653,252.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.

Avera Sacred Heart Hospital
Part V, Section B, Line 5: Avera Sacred Heart utilized aspects of the Community Health Needs Assessment and Implementation Planning toolkit developed by the South Dakota Department of Health and focus groups conducted by Maximizing Excellence, LLC to conduct the FY2022 Community Health Needs Assessment. The process involved determining the participant's opinions on the community's strengths, weaknesses, resources and improvements. Careful consideration was taken to ensure that input gathered was representative of the community at large including the medically underserved, low-income or minority populations.

Avera Creighton Hospital
Part V, Section B, Line 5: Avera Creighton Hospital, in collaboration with the North Central District Health Department (NCDHD), used community stakeholder meetings, a focus group meeting and surveys to determine the community's strengths, weaknesses, resources and improvements. Those providing community input represented the medically underserved, low-income and minority populations as they serve with these populations through their activities.

Avera Creighton Hospital
Part V, Section B, Line 6a: Antelope Memorial HospitalAvera St. Anthony's HospitalWest Holt HospitalCHI Plainview HospitalOsmond General Hospital

Avera Creighton Hospital
Part V, Section B, Line 6b: North Central District Health DepartmentHolt County Economic DevelopmentNorthstarValentine Community SchoolCentral Nebraska Community Action PartnershipProteus, Inc. Services to Empower FarmworkersLegal Aid of NebraskaO'Neill Public Schools

Avera Sacred Heart Hospital
"Part V, Section B, Line 11: Avera Sacred Heart conducted a community health needs assessment during FY2022. Two significant needs were identified and prioritized in the community health needs assessment process: Behavioral health and substance abuse/addiction and workforce and health care capacity.The following actions will be taken in future years to address the identified and prioritized community health needs:BEHAVIORAL HEALTH AND SUBSTANCE ABUSE/ADDICTIONIncrease community resources relating to behavioral health with special focus on substance abuse and addiction issues.*Analyze the feasibility of an inpatient behavioral health unit at Avera Sacred Heart Hospital.*Advocate for and support the Lewis and Clark Behavioral Health Services, Inc. residential chemical dependency program and unit.*Advocate for and support the Lewis and Clark Behavioral Health Services, Inc. as they seek to build a new facility.*Actively recruit psychologists and/or psychiatrists with specialties in behavioral health.*Implement the Avera's ""Ask the Question: Are you thinking about suicide"" campaign.*Implement strategies identified through the Communities that Care grant program as appropriate and feasible.*Implement SBIRT (Screening, Brief Intervention, and Referral to Treatment), an evidence-based practice used to identify, reduce, and prevent problematic use, abuse, and dependence on alcohol and illicit drugs.*Implement the Edinburgh Scale for depression and suicide screening for OB patients.WORKFORCE AND HEALTH CARE CAPACITYIncrease workforce and health care capacity to adequately prepare Avera Sacred Heart to meet the future needs of the community.*Further develop and implement an Avera Sacred Heart version of Avera Academy that fits the Yankton community.*Further develop and implement the Avera Scholars program with Mount Marty University.*Develop and implement an Avera Nurse Residency Program at Avera Sacred Heart for new college graduates.*Develop and implement a Nurse Recruitment Team with the Avera Sacred Heart Endowed Chair of Nursing recipient at Mount Marty University.*Utilize Build Dakota Scholarships to build a workforce for Avera Sacred Heart in difficult to recruit positions.*Continue to promote the Avera Student Loan Program benefit and evaluate critical needs for eligibility with the program.Many of these activities are continuations of activities the hospital has been conducting related to the prior community health needs assessment.The following health needs were identified but were not selected for focus: Transportation and affordability. Avera Sacred Heart is committed to providing high quality health care services to meet the needs of its service area. Although not the focus, Avera Sacred Heart is actively implementing cost saving initiatives to contain or minimize costs and will continue to advocate for increased transportation availability in the community. Avera Sacred Heart continued to address the community health needs identified in the community health needs assessment completed in 2018. The following community health priority areas were identified and the following actions were taken during FY22.CHRONIC DISEASE & NUTRITIONEnhance the nutrition wellness section of the Avera Sports Coach Rozy strength and conditioning programs.Provide annual education and/or cooking demonstrations on healthy eating as a component for wellness for those who experience chronic diseases.FY2022: Continued to provide education on healthy eating as a component for wellness via social media for those who experience chronic diseases. This has been done on both the Avera Health and Avera Sacred Heart social media sites. Dieticians worked with the Avera Sports Coach Rozy program to integrate nutrition education into the programs.Enhance the relationship between Avera Sacred Heart Hospital and the local grocery store Hy-Vee's dietician.Enhance the nutrition education provided to the Lewis and Clark Behavioral Health Services, Inc. residential chemical dependency program and unit located on third floor of the Avera Sacred Heart Hospital Benedictine Center.FY2022: Continued to enhance and implement nutrition education. Nutrition education and enhancements were made to the service provided to the Lewis and Clark residential chemical dependency program and unit.Provide an annual meal preparation and planning program.FY2022: Meal preparation and planning program continued to be offered on the Avera Health social media sites. This information has been shared on the Avera Sacred Heart social media site as well.BEHAVIORAL HEALTH & SUBSTANCE ABUSEAnalyze the feasibility of an inpatient behavior health unit at Avera Sacred Heart Hospital. Advocate for and support the Lewis and Clark Behavioral Health Services, Inc. residential chemical dependency program and the unit located on the third floor of the Avera Sacred Heart Hospital Benedictine Center.FY2022: The Lewis and Clark Behavioral Health Services, Inc. residential chemical dependency program is actively planning for expansion in a new building project.Actively recruit psychologists and/or certified nurse practitioners with specialties in behavioral health for the Avera Medical Group Behavioral Health Clinic.FY2022: Initial recruitment was unsuccessful and paused during the Covid pandemic. The recruitment process will be reassessed in the future.Provide educational and informational opportunities for the community.FY2022: Continued to provide posts regarding community educational and informational opportunities, including wellness and nutrition tips, on Avera Health and Avera Sacred Heart's social media sites.Implement the Avera Medical Group's opioid reduction strategies in the Avera Medical Group clinics in the Avera Sacred Heart Region.FY2022: Continued the opioid reduction strategies previously implemented. Avera Medical Group Pain Management will implement quarterly behavioral health evaluations for all patients on a pain contract.FY2022: Continued to maintain the quarterly evaluation program as implemented."

Avera Creighton Hospital
Part V, Section B, Line 11: Avera Creighton conducted a community health needs assessment during FY2022. The priority areas to be addressed by Avera Creighton include: Behavioral Health and Heart Health.The following actions will be taken in future years to address the identified and prioritized community health needs:BEHAVIORAL HEALTH*Continue the screenings, education, counseling, transportation and other programs implemented under previous health need assessments*Continue to collaborate with other facilities and institutions to improve behavioral health care and services in the community*Improve access to behavioral health providers*Behavioral health education for health care providers and nursing staff*Behavioral health education in collaboration with the area school system on suicide prevention*Behavioral health education for the community*Utilize media outlets to increase awareness of Mental Health and SuicideHEART HEALTH*Continue screenings and programs implemented under previous health need assessments*Explore options for increasing the number and location of blood pressure screenings in the community*Patient education campaign focused on definition and treatment of hypertension*Explore options for bringing Planet Heart screenings to the community*Increase amount of CPR certified Instructors in the communityMany of these activities are continuations of activities the hospital has been conducting related to the prior community health needs assessment.The following health need was identified but will not be addressed, however, Avera Creighton Hospital will continue to assess and monitor the need through planning efforts to serve the health and well-being of the service area of the communities.*No after-hours care options for non-emergent conditions outside of Emergency Department*Avera Creighton Hospital has limited staffing availability to expand clinic hours in the evening, which leaves the Emergency Department as the only option for after-hours care in the area.Avera Creighton continued to address the community health needs identified in the community health needs assessment completed in 2018. The following community health priority areas were identified and the following actions were taken during FY22.BEHAVIORAL HEALTH*Improve access to behavioral health providers*Behavioral health education for health care providers and nursing staff*Behavioral health education in collaboration with the area school system on suicide prevention*Behavioral health education for the communityFY2022: *Clinic providers continue to use the Avera Behavioral Health Outpatient Triage program. This allows them to access a behavioral health counselor virtually to visit with the patient on the day they presented to the clinic rather than waiting to schedule an appointment. *Continue to require PSQ-9 screening question for every patient seen in the clinic, the emergency room or admitted as an inpatient. The PSQ-9 screening tool helps evaluate a patient's overall mental health with a focus on depression. The 9 questions generate a score, symptom severity and action needed based on the score. If this screen is positive, it will generate further screening for suicide risk to help the provider determine next steps in treatment. *In September 2021 the implementation of eSANE was done through a grant that provided equipment and training for providers and nursing staff to care for a patient that has been sexually assaulted. This included developing a relationship with Bright Horizons so they would be contacted to provide advocacy for the patient.*The hospital completed the Age Friendly designation in fall of 2021. This designation involves reliably providing a set of 4 evidence-based elements to all older adults known as the 4 M's: What Matters, Medication, Mentation and Mobility. During the work on Mentation, a Delirium guide for patients, family members and caregivers was developed. The NuDESC Delirium Screen was added as a required screening in the EMR for inpatients and is completed every 12 hours. Providers and nursing staff were trained in symptoms of delirium, the use of the screening tool and how to help patients that are experiencing delirium. These Delirium guides are given to patients and family on admission as appropriate. HYPERTENSION*Explore options for increasing the number and location of blood pressure screenings in the community*Patient education campaign focused on definition and treatment of hypertensionFY2022: Continued the services of the Patient Coordinated Care nurse position. This nurse focuses on chronic health conditions for any patient of AMG clinics in Creighton, Verdigre, Niobrara, Crofton, Hartington and Pierce. This nurse provides education to the patients on hypertension, medications and other ways to reduce blood pressure. DIABETES*Continued evaluation of the current diabetic education program*Market the current diabetic program through collaboration with marketing to distribute information in multiple ways*Provide an educational program on diabetes recognition and treatmentFY2022: Continued the services of the Patient Coordinated Care nurse position. This nurse focuses on chronic health conditions for any patient of AMG clinics in Creighton, Verdigre, Niobrara, Crofton, Hartington and Pierce. This nurse provides education to diabetic patients on diet, exercise, monitoring blood sugar and diabetic medications. The Covid-19 pandemic did have an impact on the implementation of the CHNA activities from March 2020 to the spring of 2022 but progress was made on each focus area despite the pandemic.

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.

Part V, Section A organization's website
The website for Avera Sacred Heart Hospital is:avera.org/locations/sacred-heart/The website for Avera Creighton Hospital is:avera.org/locations/profile/avera-creighton-hospital

Part V, Section B, Line 7a, 7b, and 10a:
www.avera.org/about/community-health-needs-assessments/#sacredwww.avera.org/about/community-health-needs-assessments/#creighton

Part V, Section B, Line 16a, 16b, and 16c:
avera.org/patients-visitors/charity-patient-assistance-programs/financial-assistance-forms/

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:
A combination of costing methodology was used to calculate the amounts reported in the table. A cost accounting system was used to calculate Medicaid and Means-tested Government Program expenses and shortfalls and Subsidized Health Services for our tertiary medical center. A cost to charge ratio derived from Worksheet 2, Ratio of Patient Care Cost-to-Charges was used to calculate charity care at cost for all entities and Medicaid and Means-tested Government Program expenses and shortfalls and Subsidized Health Services for any operations outside of the tertiary medical center. For all other amounts, costs and revenues as reflected by the general ledger system were used.

Part II, Community Building Activities:
The community building activities include monetary assistance to organizations that focus their efforts on providing furniture for low income families, neighborhood improvement projects in high needs areas, children and youth development programs, local economic development, and job creation and training programs.

Part III, Line 2:
The amount on line 2 represents implicit price concessions. The Organization determines its estimate of implicit price concessions based on its historical collection experience with the respective class of patients and residents.

Part III, Line 4:
The footnote to the Organization's financial statements that describes implicit price concession is located in the audited financial statement report on pages 19 and 20.

Part III, Line 8:
Sacred Heart Health Services provides services to patients under the Medicare program knowing they may not recover all the costs associated with providing these services. Providing these services is essential to these patients and the community and increases their access to healthcare services. Therefore, in years the costs associated with services provided under the Medicare program are not completely covered, the Medicare shortfall is considered a community benefit. 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.

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:
Uninsured patients who hold an inpatient status are counseled by a Patient Advocate to screen them for coverage eligibility and to assist in payer source enrollment. Those that are not eligible are provided a charity care application along with instructions on how to fill out the application. All patients receive statements that indicate who to contact should they need financial assistance. In addition, all patients receive a summary of financial assistance upon registration, as well as in their final statement. Should a patient contact Patient Financial Services and indicate inability to pay, they are transferred to a financial counselor to assist them with the financial assistance application process. Also, inpatient and same day surgery patients receive a brochure in their admissions packet. Pre-collection letters also include information regarding the financial assistance and uninsured programs.

Part VI, Line 4:
Avera Sacred Heart is a 99-bed hospital in Yankton, South Dakota. Avera Sacred Heart primarily serves the city and county of Yankton and the counties of Bon Homme, Charles Mix, Hutchinson and Clay in South Dakota and counties of Knox and Cedar in Nebraska. The majority of discharges are from Yankton County. According to the U.S. Census Bureau Quick Facts 2021 data, the estimated population of Yankton County as of July 1, 2021 is 23,297 and is predominately white at 91.6%. It is estimated that 20.1% of the population is 65 years and over. The median household income is $61,878 with a 10.4% poverty rate. Uninsured individuals under age 65 is estimated at 12.6%.

Part VI, Line 6:
Avera is a sponsored ministry of the Benedictine and Presentation Sisters. The communities in which Avera 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.

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 hours 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 University students. The Hospital is also proud of the fact that 183 individuals chose to volunteer at the hospital facility in Yankton during fiscal year 2022.