Community Benefit Insight - Tax-exempt hospital

View data for this organization below, or select additional hospitals to create a comparison view.

Search tax-exempt hospitals
for comparison purposes.

Avera Gettysburg

Avera Gettysburg Hospital

606 East Garfield Street
Gettysburg, SD 57442

Bed count	10	Medicare provider number	431302	Member of the Council of Teaching Hospitals	NO	Children's hospital	NO

EIN: 460234354

Display data for year:

Community Benefit Spending- 2021
(as % of functional expenses, which all tax-exempt organizations report on Form 990 Schedule H)

34.11%

Spending by Community Benefit Category- 2021
(as % of total functional expenses)

* = CBI denoted preventative categories

Community Benefit Spending Compared to Functional Expenses, 2010-2021

Additional data

Community Benefit Expenditures: 2021

All tax-exempt organizations file a Form 990 with the IRS for every tax year. If the tax-exempt organization operates one or more hospital facilities during the tax year, the organization must attach a Schedule H to Form 990. On Part I of Schedule H, the organization records the expenditures it made during the tax year for various types of community benefits; 9 types are shown on this web tool. By default, this web tool presents community benefit expenditures as a percentage of the organization’s functional expenses, which it reports on Form 990, Part IX, Line 25, Column A. (The more commonly heard term, ‘total operating expenses’, which organizations report to CMS, is generally about 90% of the ‘functional expenses’). The user may change the default to see the dollar expenditures.
Amount spent in the following IRS community benefit categories:

Financial Assistance at cost as % of operating expenses	$ 90,000 0.77 %
Medicaid as % of operating expenses	$ 0 0 %
Costs of other means-tested government programs as % of operating expenses	$ 0 0 %
Health professions education as % of operating expenses	$ 0 0 %
Subsidized health services as % of operating expenses	$ 3,874,733 33.31 %
Research as % of operating expenses	$ 0 0 %
Community health improvement services and community benefit operations* as % of operating expenses Note: these two community benefit categories are reported together on the Schedule H, part I, line 7e.	$ 0 0 %
Cash and in-kind contributions for community benefit* as % of operating expenses	$ 3,681 0.03 %
Community building* as % of operating expenses	$ 0 0 %

* = CBI denoted preventative categories

Community building activities details:

Did tax-exempt hospital report community building activities?	Not available
Number of activities or programs (optional)	0
Physical improvements and housing	0
Economic development	0
Community support	0
Environmental improvements	0
Leadership development and training for community members	0
Coalition building	0
Community health improvement advocacy	0
Workforce development	0
Other	0
Persons served (optional)	0
Physical improvements and housing	0
Economic development	0
Community support	0
Environmental improvements	0
Leadership development and training for community members	0
Coalition building	0
Community health improvement advocacy	0
Workforce development	0
Other	0
Community building expense as % of operating expenses	$ 0 0 %
Physical improvements and housing as % of community building expenses	$ 0
Economic development as % of community building expenses	$ 0
Community support as % of community building expenses	$ 0
Environmental improvements as % of community building expenses	$ 0
Leadership development and training for community members as % of community building expenses	$ 0
Coalition building as % of community building expenses	$ 0
Community health improvement advocacy as % of community building expenses	$ 0
Workforce development as % of community building expenses	$ 0
Other as % of community building expenses	$ 0
Direct offsetting revenue	$ 0
Physical improvements and housing	$ 0
Economic development	$ 0
Community support	$ 0
Environmental improvements	$ 0
Leadership development and training for community members	$ 0
Coalition building	$ 0
Community health improvement advocacy	$ 0
Workforce development	$ 0
Other	$ 0

Other Useful Tax-exempt Hospital Information: 2021

In addition to community benefit and community building expenditures, the Schedule H worksheet includes sections on what percentage of bad debt can be attributable to patients eligible for financial assistance, and questions on the tax-exempt hospital's debt collection policy. When searching a specific tax-exempt hospital in this web tool, Section II provides information about bad debt and the financial assistance policy, and whether the state in which the tax-exempt hospital resides has expanded Medicaid coverage under the federal ACA.

Of the tax-exempt hospital’s overall operating expenses, amount reported as bad debt as % of operating expenses	$ 424,909 3.65 %
Is the tax-exempt hospital considered a "sole community hospital" under the Medicare program?	NO

Information about the tax-exempt hospital's Financial Assistance Policy and Debt Collection Policy
The Financial Assistance Policy section of Schedule H has changed over the years. The questions listed below reflect the questions on the 2009-2011 Schedule H forms and the answers tax-exempt hospitals provided for those years. The Financial Assistance Policy requirements were changed under the ACA. In the future, as the Community Benefit Insight web site is populated with 2021 data and subsequent years, the web tool will also be updated to reflect the new wording and requirements. In the meantime, if you have any questions about this section, we encourage you to contact your tax-exempt hospital directly.

Does the organization have a written financial assistance (charity care) policy?	YES
Did the tax-exempt hospital rely upon Federal Poverty Guidelines (FPG) to determine when to provide free or discounted care for patients?	YES
Amount of the tax-exempt hospital’s bad debt (at cost) attributed to patients eligible under the organization’s financial assistance (charity care) policy as % of operating expenses	$ 0 0 %

Did the tax-exempt hospital, or an authorized third party, take any of the following collection activities before determining whether the patient was eligible for financial assistance:
Under the ACA, states have the choice to expand Medicaid eligibility for their residents up to 138% of the federal poverty guidelines. The Medicaid expansion provision of the ACA did not go into effect until January 2014, so data in this web tool will not reflect each state's current Medicaid eligibility threshold. For up to date information, please visit the Terms and Glossary under the Resources tab.
The federal poverty guidelines (FPG) are set by the government and used to determine eligibility for many federal financial assistance programs. Tax-exempt hospitals often use FPG guidelines in their Financial Assistance policies to determine which patients will qualify for free or discounted care.
In addition to the federal requirements, some states have laws stipulating community benefit requirements as a result of tax-exemption. The laws vary from state to state and may require the tax-exempt hospitals to submit community benefit reports. Data on this web tool captures whether or not a state had a mandatory community benefit reporting law as of 2011. For more information, please see Community Benefit State Law Profiles Comparison at The Hilltop Institute.

Community Health Needs Assessment Activities: 2021

The ACA requires all 501(c)(3) tax-exempt hospitals to conduct a Community Health Needs Assessment (CHNA) every three years, starting with the hospital's tax year beginning after March 23, 2012. The 2011 Schedule H included an optional section of questions on the CHNA process. This web tool includes responses for those hospitals voluntary reporting this information. The web tool will be updated to reflect changes in these questions on the 2012 and subsequent Schedule H forms.

Did the tax-exempt hospital report that they had conducted a CHNA?	YES
Did the CHNA define the community served by the tax-exempt hospital?	YES
Did the CHNA consider input from individuals that represent the broad interests of the community served by the tax-exempt hospital?	YES
Did the tax-exempt hospital make the CHNA widely available (i.e. post online)?	YES
Did the tax-exempt hospital adopt an implementation strategy to address the community needs identified by the CHNA?	YES

Supplemental Information: 2021

This section presents qualitative information submitted by the hospital, verbatim from the 990H record.

Statement of Program Service Accomplishments
Description of the organization's program service accomplishments for each of its three largest program services, as measured by expenses. Section 501(c)(3) and 501(c)(4) organizations are required to report the amount of grants and allocations to others, the total expenses, and revenue, if any, for each program service reported.

4A (Expenses $ 10017804 including grants of $ 5171) (Revenue $ 11670929)
Avera Gettysburg's mission is to provide healthcare services to Gettysburg, South Dakota residents and residents of the surrounding counties including Potter, Sully Faulk, and Dewey. Avera Gettysburg is a 501(c)(3) organization affiliated with Avera Health. Avera Gettysburg consists of a 7-bed critical access hospital and a 53-bed nursing home in Gettysburg, South Dakota. Avera Gettysburg provides acute care, swing-bed, and long-term healthcare services. Services include emergency department, surgery, xray, laboratory, CT, outpatient treatment, physical therapy, occupational therapy, ambulatory care, long-term care and senior living apartments. Following is a breakdown of these statistics by facility:Avera Gettysburg Hospital89 Acute patient discharges56 Swing Bed patient discharges6,386 Outpatient visits546 Swing-bed patient days4,367 Clinic visitsOahe Manor11,585 Long-term resident days27 Long Term Care patient dischargesAvera Gettysburg 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 $145,977.Avera Gettysburg 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 Gettysburg 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 or persons and institutions. Avera Gettysburg 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.

Facility Information

Schedule H (Form 990) Section C. Supplemental Information for Part V, Section B.

Avera Gettysburg Medical Center
Part V, Section B, Line 5: Avera Gettysburg conducted a focus group in November 2021 to gain input on the current and future community health needs. The group included community leaders from ministerial communities, health care, emergency medical services (EMS) and local law enforcement, governance members-representing a voice of the poor and various business members of the community. Vilas Pharmacy, Whitlock Bay Economic Development Corp., Gettysburg Ambulance Service, Gettysburg Police Department, Gettysburg City Council, CHS River Plains, Great Western Bank, Gettysburg-In-Action (GIA) and several members from the fundraising committee, which includes business representation from the main local restaurant (Mini Mall), Logan Electric and homeowners who rent homes to those in the community, all had representation during the focus group. Individuals from the community who represent broad interests of the community served including medically underserved, low-income or minority populations were in attendance. Following the focus group, an electronic survey was sent to members of the groups listed above, as well as school officials, other community business leaders, and employees of the healthcare campus.

Avera Gettysburg Medical Center
Part V, Section B, Line 11: Avera Gettysburg conducted a community health needs assessment during FY2022. The prioritization process was done by the hospital administration and other healthcare professionals, along with community members serving on the new healthcare facility's fundraising committee, all of whom are highly engaged with the community and general community health needs. The process took into consideration the size of the problem (i.e. how many people does it impact), urgency of the health need, the potential impact for the community, the feasibility of being able to address the concern and the value it would bring to the community.Based on the results of this assessment, Avera Gettysburg will work to address the following identified significant community health needs:*Increase community wellness, specifically through a new recreation center*Care for the elderly and aging population*Secure more mental health services The following actions will be taken in future years to address the identified and prioritized community health needs:INCREASE COMMUNITY WELLNESS, SPECIFICALLY THROUGH A NEW RECREATION CENTER*Continue to assist with the fundraising and planning for a new community wellness/recreation center*Open the therapy gym in the facility to community members to partake in after-hours wellness center use*Registered dietician will hold free community cooking classesCARE FOR THE ELDERLY AND AGING POPULATION*Engage with the local senior center to provide free blood pressure checks weekly*Partner with Avera Foundation and local community members on making contributions to the Oahe Manor nursing home and Oahe Villa Independent living physical infrastructure updates*Continue to recruit nursing staff to the community to provide long term care and home health services*The facility will work to engage a SD department of social services representative to talk about aging services in the countrySECURE MORE MENTAL HEALTH SERVICES*Implementation of Avel eBahavioral Health program *Partner with local counselor and surrounding area counseling services to form relationships for better referral networks for our local patientsThe following health needs were identified but will not be addressed:*Housing options - safe and affordable*Workforce concerns*Healthy eating optionsMany of these activities are continuations of activities the hospital has been conducting related to the prior community health needs assessment. Avera Gettysburg 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.NEW HEALTHCARE FACILITY*Approval to proceed with a new health care facility which will include a critical access hospital and clinic.*Working to bring in additional health care services including: Upper and lower endoscopy scopes, specialties such as orthopedics, dermatology and wound care, and use of telemedicine to access mental health services.FY2022 Update:The new healthcare center, now doing business as Avera Missouri River Health Center, includes both hospital and clinic and opened December, 2020. Continued work on the increase of services offered locally brought pain management and podiatry to the list of visiting providers starting in August 2021. Orthopedic, wound care and ultrasound services were explored further. INCREASE ORGANIZED WELLNESS PROGRAMS INCLUDING WALKING AND BIKING TRAILS*New wellness center open to the general public.*Gettysburg Economic Development Committee is working with the Gettysburg City Council on the feasibility of a walking and bike trail. A representative from Avera Gettysburg Hospital is a member of the committee.*Dietician will work to offer the community diabetes education, seminars on proper nutrition, reading nutrition labels and health eating.FY2022 Update:FY2022 brought the completion of the highway project, offering a sidewalk on both sides of the highway for better accessibility and walkability through town. Fundraising and involvement amongst the healthcare facility continued for the creation of a recreation center. STRENGTHEN HOME CARE AND HOSPICE OPTIONS*Educate the community on the home health and hospice services available.*Hospice staff to provide Hospice education during nurse's staff meetings.*Care transitions implemented to increase home healthcare referrals.*All skilled Swing Bed patients will have a Home Care referral done at discharge.*Acute admissions identified as high risk for readmission will be referred to Home Care for evaluation.FY2022 Update:Avera@Home's staffing has stabilized and through the continuity of the main nurse for our service area, we have kept Avera Oahe Manor's hospice census at or above 10% of total census. These residents and loved ones continued to benefit from the service. Avera@Home implemented the use of a Patient Care Coordinator to help with education, both internally and in the community, and assist with referral process.

Avera Gettysburg Medical Center
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 Gettysburg Medical Center
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 Gettysburg Medical Center
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 Gettysburg Medical Center
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 B, Lines 7a, 7b and 10a:
avera.org/about/community-health-needs-assessments/#gettysburg

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

Part V, Section A website address:
avera.org/locations/profile/avera-missouri-river-health-center/

Supplemental Information

Schedule H (Form 990) Part VI

Part I, Line 3c:
The methodology used to determine eligibility for financial assistance takes into consideration income, net assets, family size and resources available to pay for care. In addition, presumptive charity care may be applied in situations where all other avenues have been exhausted.

Part I, Line 7:
Charity care expense was converted to cost using an overall cost-to-charge ratio addressing all patient segments. Subsidized health services were calculated based on a combination of the Medicare cost report and an overall cost-to-charge ratio for certain expenses. Cash and in-kind contributions are reported based on actual expenses recorded in the general ledger.

Part I, Line 7g:
Provider based clinic costs are included in subsidized health services. Revenues of $647,252 and costs of $1,047,156 were included for a net community benefit of $399,904.

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:
Avera Gettysburg 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:
In addition to identifying needs through the CHNA process, administration is made aware of needs of the community served through quarterly meetings of medical staff who discuss needs identified through patient interaction, communications from the hospital auxiliary and weekly Rotary meetings attended by administration. During the discharge process, staff visit with high risk patients to determine if they have support at home. If not, staff work with the patient's family members or neighbors to help meet their needs.

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 Gettysburg is a 7-bed critical access hospital. The primary service area is defined as Potter County, South Dakota, including the communities of Gettysburg, Hoven, Tolstoy and Lebanon. Over 90% of inpatient discharges were from Potter County. According to the U.S. Census Bureau Quick Facts 2021 data, the estimated population of Potter County as of July 1, 2021 is 2,475 and is predominately white at 92.8%. It is estimated that 27.8% of the population is 65 years and over. The median household income is $57,120 with a 9.4% poverty rate. Uninsured individuals under age 65 is estimated at 11.1%.

Part VI, Line 5:
The Hospital serves all persons in the community on a non-discriminatory basis. Avera Gettysburg operates an emergency room that is open to all persons regardless of ability to pay. Avera Gettysburg has an open medical staff with privileges available to all qualified physicians in the area. The governing body is comprised of primarily independent persons representative of the community as a whole. Avera Gettysburg participates in Medicaid, Medicare, Champus, Tricare and/or Other Government sponsored Health Care Programs.

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 benefit needs. In keeping with the Catholic Healthcare 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.

Operating expenses	$ 11,632,628
Total amount spent on community benefits as % of operating expenses	$ 3,968,414 34.11 %