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Avera Queen of Peace
525 North Foster Street
Mitchell, SD 57301
EIN: 460224604
The hospital that you have selected is part of a multi-facility organization that reports community benefit expenditures in the aggregate and not by individual hospital. The data shown below are for the multi-facility organization. We encourage you to contact the individual hospital directly if you would like community benefit information on the hospital.Learn more
Individual Facility Details: De Smet Memorial Hospital306 Prairie Ave Sw
De Smet, SD 57231
De Smet, SD 57231
3 hospitals in organization:
(click a facility name to update Individual Facility Details panel)
(click a facility name to update Individual Facility Details panel)
| Bed count | 6 | Medicare provider number | 431332 | Member of the Council of Teaching Hospitals | NO | Children's hospital | NO |
Avera Queen of PeaceDisplay data for year:
Community Benefit Spending- 2021
(as % of functional expenses, which all tax-exempt organizations report on Form 990 Schedule H)
(as % of functional expenses, which all tax-exempt organizations report on Form 990 Schedule H)
3.28%
Spending by Community Benefit Category- 2021
(as % of total functional expenses)
(as % of total functional expenses)
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.
Operating expenses $ 127,364,994 Total amount spent on community benefits as % of operating expenses$ 4,178,569 3.28 %- Amount spent in the following IRS community benefit categories:
Financial Assistance at cost as % of operating expenses$ 556,624 0.44 %Medicaid as % of operating expenses$ 2,392,374 1.88 %Costs of other means-tested government programs as % of operating expenses$ 28,845 0.02 %Health professions education as % of operating expenses$ 28,920 0.02 %Subsidized health services as % of operating expenses$ 1,025,670 0.81 %Research as % of operating expenses$ 0 0 %Community health improvement services and community benefit operations*
as % of operating expensesNote: these two community benefit categories are reported together on the Schedule H, part I, line 7e.$ 575 0.00 %Cash and in-kind contributions for community benefit* as % of operating expenses$ 145,561 0.11 %Community building*
as % of operating expenses$ 10,808 0.01 %- * = CBI denoted preventative categories
- Community building activities details:
Did tax-exempt hospital report community building activities? YES 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$ 10,808 0.01 %Physical improvements and housing as % of community building expenses$ 0 0 %Economic development as % of community building expenses$ 8,168 75.57 %Community support as % of community building expenses$ 0 0 %Environmental improvements as % of community building expenses$ 0 0 %Leadership development and training for community members as % of community building expenses$ 1,968 18.21 %Coalition building as % of community building expenses$ 672 6.22 %Community health improvement advocacy as % of community building expenses$ 0 0 %Workforce development as % of community building expenses$ 0 0 %Other as % of community building expenses$ 0 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$ 6,919,855 5.43 %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:
Reported to credit agency Not available 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.
After enactment of the ACA, has the state in which this tax-exempt hospital is located expanded Medicaid? NO 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.
If not, is the state's Medicaid threshold for working parents at or below 76% of the federal poverty guidelines? YES 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.
Does the state in which the tax-exempt hospital is located have a mandatory community benefit reporting statute? NO
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 $ 115305369 including grants of $ 32479) (Revenue $ 127578049) Avera Queen of Peace's mission is to provide healthcare services to Mitchell, South Dakota residents and residents of the surrounding area. Avera Queen of Peace is a 501(c)(3) organization affiliated with Avera Health. Avera Queen of Peace consists of 50 acute beds and a 84-bed nursing home in Mitchell, SD, a 16-bed critical access hospital in Wessington Springs, SD, a 6-bed critical access hospital in De Smet, SD and 10 physician clinics. The physician clinics include primary care, OB/GYN, pediatrics, orthopedics, general surgery, internal medicine, radiation, radiology, oncology, dermatology, therapy, ophthalmology and optometry. They provide acute care and long-term healthcare services. Following is a breakdown of these statistics by facility:Avera Queen of Peace Hospital1,691 Acute patient discharges459 Newborn patient discharges60 Swing Bed patient discharges100,780 Outpatient visits642 Swing-bed patient days862 Newborn patient days92,305 Clinic visitsAvera Brady Health and Rehabilitation93 Long Term Care patient discharges21,916 Long-term care resident daysAvera Weskota Memorial Medical Center (CAH)60 Acute patient discharges37 Swing Bed discharges4,789 Outpatient visits368 Swing-bed patient daysAvera De Smet Memorial Hospital (CAH)61 Acute patient discharges17 Swing Bed patient discharges13,065 Outpatient visits119 Swing-bed patient days3,955 Clinic visitsAvera Queen of Peace 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 $2,069,042.Avera Queen of Peace 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 Queen of Peace 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 Queen of Peace 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.
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Facility Information
Schedule H (Form 990) Section C. Supplemental Information for Part V, Section B.
Avera Queen of Peace Hospital Part V, Section B, Line 5: The assessment process, initiated by Avera Queen of Peace, is an effort to identify significant unmet health needs in the community. The process is an opportunity to review, identify and analyze strengths and barriers to the health of the community. Mission leaders at Avera Queen of Peace collected primary data through stakeholder interviews and community surveys. Avera Queen of Peace contracted with inHealth Strategies to analyze primary data, provide technical assistance, and prepare the CHNA and implementation strategy. inHealth Strategies collected and analyzed secondary data. Throughout the data collection process, steps were taken to ensure the hospital's community health needs assessment took into account input from persons who represent the broad interests of the community, including the medically underserved, minority, senior citizens, children and low-income populations. The following organizations were represented in the process:- Mitchell Area Development Corporation- Mitchell Department of Public Safety- Mitchell Fire & Emergency Management Services (EMS)- Hanson County Sheriff's Office- Dakota Wesleyan University- Episcopal Church- Mitchell School District- Mitchell Safe House- Palace Transit, Senior Nutrition- Salvation Army- The Caring Closet- SDDOH County Health Nurse - Davison County
Avera Weskota Memorial Medical Center Part V, Section B, Line 5: The assessment process, initiated by Avera Weskota, is an effort to identify significant unmet health needs in the community. Mission leaders at Avera Queen of Peace collected primary data through stakeholder interviews and community surveys. Avera Weskota Hospital contracted with inHealth Strategies to analyze primary data, provide technical assistance, and prepare the CHNA and implementation strategy. inHealth Strategies collected and analyzed secondary data. The process involved determining the participant's opinions on our community's strengths, weaknesses, resources and improvements. Throughout the data collection process, steps were taken to ensure the hospital's community health needs assessment took into account input from persons who represent the broad interests of the community, including the medically underserved, minority, senior citizens, children and low-income populations. The following organizations were represented in the process: City of Wessington Springs - Mayor's Office/Business Owner Jerauld County Auditor Ministerial Association Jerauld County Commissioner/Business Owner South Dakota Department of Health and Human Services Wessington Springs School District
Avera De Smet Memorial Hospital Part V, Section B, Line 5: Avera De Smet Hospital hired inHealth Strategies to conduct the focus group and analyze the results. The process involved determining the participant's opinions on our community's strengths, weaknesses, resources and improvements. Those providing community input were chosen for their familiarity with the needs of medically underserved, low-income and minority populations as they serve with these populations through their activities. The following organizations were represented in the process: Inter-Lakes Community Action Partnership (ICAP) - Kingsbury County Eastern South Dakota SHINE (seniors over 60 services) Kingsbury County Sheriff's Department City of De Smet Kingsbury Court House South Dakota Department of Social Services De Smet United Methodist Church American Lutheran Church, De Smet Community Health Nurse De Smet School District
Avera Queen of Peace Hospital "Part V, Section B, Line 11: Avera Queen of Peace conducted a community health needs assessment during FY2022. After review of the primary and secondary data, the Avera Queen of Peace leadership team weighed the findings against available hospital and community resources and the likelihood that reasonable interventions would yield positive, sustainable health improvement. These criteria were used as they prioritized the significant health needs of the community.Based on the results of this assessment, Avera Queen of Peace is committed to addressing the following identified significant community health needs: Continue to explore creative solutions that remove barriers to community health needs posed by Behavioral Health and Substance Abuse issues; and Support healthy lifestyle choices to help individuals manage their weight and associated chronic diseases.The following actions will be taken in future years to address the identified and prioritized community health needs:Behavioral Health and Substance Abuse issues *Increase access to the three current behavioral health providers imbedded in Access Health Mitchell. *Increase utilization of eBehavioral Health consults in the Emergency Department. *Implement the Avera's ""Ask the Question: Are you thinking about suicide"" campaign in the Avera facilities in the Avera Queen of Peace region. *Implement strategies identified through the Communities that Care grant program as appropriate and feasible for Avera Queen of Peace Hospital. *Implement SBIRT (Screening, Brief Intervention, and Referral to Treatment) in the Avera Queen of Peace Hospital emergency department. SBIRT is 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 at Avera Queen of Peace Hospital and follow-up visits at Access Health for OB and pediatric patients.Healthy Lifestyle Choices *Provide nutrition and wellness information at the Health Fairs Avera Queen of Peace attends. *Provide annual education and/or cooking demonstrations on healthy eating as a component for wellness for those who experience chronic diseases. *Primary Care Providers at Access Health in Mitchell commit to referring patients, as appropriate, to the registered dieticians from Avera Queen of Peace Hospital for healthy choices counseling. *Providers at Access Health in Mitchell commit to increasing the performance rate for child and adolescent weight management. *Avera Medical Group opened a new clinic in Sioux Falls with a specialized focus on weight management. Primary Care Providers at Access Health in Mitchell commit to referring patients, as appropriate, to the Avera Medical Group Comprehensive Weight Management clinic. *Analyze the feasibility of developing community or employee gardening plots at the Avera Queen of Peace Hospital campus. *Implement Good and Healthy South Dakota's Vending Munch Code to increase healthier food and drink options and selection on the Avera Queen of Peace Hospital campus.The following health needs were identified but will not be addressed: Transportation Affordable HousingAvera Queen of Peace does not currently have the resources to directly address the identified issues of transportation and affordable housing. However, the leadership team recognizes that the needs exist and will continue to actively participate in numerous community organizations focused on community needs and improvement. Avera Queen of Peace 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 AND SUBSTANCE ABUSEBehavioral health was identified as an area of need that Avera Queen of Peace is addressing. Access to services, early intervention, and education are critical to achieving positive outcomes for individuals and communities. The hospital has developed the following goals to address this need. -Increase psychology appointments; increase appointments with LCSW-Increase PHQ-9 screening follow-up appointments in ambulatory settings-Decrease average score on PHQ-9 screenings in in-patient settings-Decrease behavioral health crisis ED visits -Increase the number of Avera eBehavioral encountersFY 2022 - The number of psychologist appointments continues to increase. Over the past two years, the number of appointments has increased more than 127%.FY 2022 - Avera Queen of Peace continues to offer behavioral health services through telehealth services. Avera Queen of Peace also prioritized increasing behavioral health screenings in clinical workflows, particularly the use of the PHQ-9 tool in ambulatory settings.TRANSPORTATIONAnother need continuing to rise to the top of the community health needs is the need for affordable and reliable on-demand transportation. The need exists within city limits and between towns and cities for all citizens as the need to get to and from school, work, and medical appointments. Avera Queen of Peace has developed the following goals to address this need.-Create resource list/algorithm on transportation options for all relevant staff-Evaluate number of rides paid for by the AQOP Foundation-Evaluate the number of conversations AMG-Care Coordination is having with patients about transportation needs-Increase the number of those enrolled in mail-order pharmacyFY2022 - Avera Queen of Peace built a list of transportation resources. The is posted for employees to reference and use to help patients with transportation needs. Avera Queen of Peace also pursued strategies to lessen the number of trips individuals needed to take for services and supplies. Avera Queen of Peace continues to enroll patients in and fill scripts through the mail-order pharmacy. The mail-order pharmacy volume has remained relatively constant.AFFORDABLE HOUSINGGood health is dependent upon adequate housing, providing dwellers a sense of privacy, security, stability, and control. A minimum of 12 of every 100 households in the county is at risk for health issues such as infectious disease and poor childhood development due to the severe cost burden of housing. Avera Queen of Peace had started a project with the City of Mitchell for the construction of affordable housing on land that Avera Queen of Peace donated. FY 2022 Update: Avera Queen of Peace Hospital does not currently have the resources to address the issues related to affordable housing. However, the 21.7 acre parcel of land donated to the City of Mitchell is still available for an affordable housing development. Avera Queen of Peace Hospital will continue to actively participate in community organizations that address housing issues."
Avera Weskota Memorial Medical Center Part V, Section B, Line 11: Avera Weskota conducted a community health needs assessment during FY2022. After review of the primary and secondary data, the Weskota leadership team weighed the findings against available resources and potential sustainability. These criteria were used as they prioritized the identified needs.Based on the results of this assessment, Avera Weskota is committed to addressing the following identified significant community health need:*Supporting healthy lifestyle choices through education with a focus on food choices, physical activity, and stress reduction.The following actions will be taken in future years to address the identified and prioritized community health need:*Provide nutrition education to the community through strategic partnerships. - Provide annual education on healthy nutrition choices. - Provide financial or like support for programs impacting the nutritional options for the students in the Weskota School District.*Provide physical activity education to the community through strategic partnerships. - Organize the annual fun run/walk 5K. - Encourage campus-wide participation in physical activity challenges through the LiveNow Avera series.*Provide stress reduction education to the community through strategic partherships. - Provide stress reduction education and participation activities.*Develop a business plan to determine the feasibility of developing community partnerships devoted to the common needs of nutrition, activity and stress reduction.The following health need was identified but will not be addressed:*Economic stressAvera Weskota will not be directly addressing the identified issue of economic stress. While the leadership team recognizes that economic stressors exist, the hospital does not have the resources to address the issue at this time.Avera Weskota 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.FURTHER COMMUNITY HEALTH EDUCATION-Increase collaboration with Horizon Healthcare on community health education-Increase educational posts on FacebookFY 2022 - Avera Weskota Memorial Medical Center continued to work with Horizon on our community health wellness and education efforts.REMOVE BARRIERS TO PRIMARY CARE ACCESS-Increase access to primary care services through hiring of additional primary care providersFY 2022 - Avera Weskota continues to look for opportunities to add healthcare services and upgrade equipment to provide patients with a greater level of comfort and accuracy in their health care.
Avera De Smet Memorial Hospital Part V, Section B, Line 11: Avera De Smet 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 De Smet will work to address the following identified significant community health need:*Supporting healthy lifestyle choices through education with a focus on food choices, physical activity, and stress reduction.The following actions will be taken in future years to address the identified and prioritized community health need:*Provide nutrition education to the community through strategic partnerships.*Provide physical activity education to the community through strategic partnerships. -Provide annual education on increasing physical activity -Encourage campus-wide participation in physical activity*Provide stress reduction education to the community through strategic partnerships.*Develop a business plan to determine the feasibility of developing community partnerships devoted to the common needs of nutrition, activity and stress reduction.The following health needs were identified but will not be addressed:*Behavioral Health*Substance AbuseAlthough the above needs were not selected for focus, Avera De Smet will continue to advocate for behavioral health resources and substance abuse resources in the community.Avera De Smet 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.REMOVE BARRIERS TO SKILLED HOME HEALTH CARE ACCESS-Increase Avera@Home Home Health patients-Increase the number of Avera@Home Home Health patients using lab servicesFY 2022 - Avera DeSmet Memorial Hospital has continued to collaborate with Avera at Home to enhance continuity of care and improve access to healthcare in the community. - Provide education and marketing materials for patients-Provide Avera@Home access to community resource informationFY 2022 - Marketing and education materials continue to be distributed to patients in both print and digital forms. Avera De Smet continues to provide topical health and wellness material to promote health and wellness in the community.
Avera Queen of Peace 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 Weskota Memorial 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 De Smet Memorial 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 Queen of Peace 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 in the billing statement. In addition, the financial assistance policy is discussed with the patient upon admission to the facility.
Avera Weskota Memorial 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 in the billing statement. In addition, the financial assistance policy is discussed with the patient upon admission to the facility.
Avera De Smet Memorial 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 in the billing statement. In addition, the financial assistance policy is discussed with the patient upon admission to the facility.
Avera Queen of Peace 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. A plain language summary is offered to all uninsured patients at the time of registration.
Avera Weskota Memorial 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. A plain language summary is offered to all uninsured patients at the time of registration.
Avera De Smet Memorial 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. A plain language summary is offered to all uninsured patients at the time of registration.
Avera Queen of Peace 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 Weskota Memorial 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.
Avera De Smet Memorial 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 Queen of Peace Hospital Part V, Section B, Line 7a, 7b and 10c: avera.org/about/community-health-needs-assessments/#queen
Avera Weskota Memorial Medical Center Part V, Section B, Ln 7a, 7b, and 10a: avera.org/about/community-health-needs-assessments/#weskota
Avera De Smet Memorial Hospital Part V, Section B, Line 7a, 7b and 10a: avera.org/about/community-health-needs-assessments/#de-smet
Part V, Section B, Lines 16a-16c The FAP, FAP Application, and plain language summary are available for all facilities at:avera.org/patients-visitors/charity-patient-assistance-programs/financial-assistance-forms/
Schedule H Part V, Section A organization's website: The website for Avera Queen of Peace Hospital is:avera.org/locations/queen-of-peace/The website for Avera Weskota Memorial Medical Center is:avera.org/locations/profile/avera-weskota-memorial-hospital/The website for Avera De Smet Memorial Hospital is:avera.org/locations/profile/avera-de-smet-memorial-hospital/
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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 on line 7a based on an overall cost-to-charge ratio addressing all patient segments. Unreimbursed Medicaid on line 7b was calculated using the costing methods to prepare the cost reports. Costs of other means-tested government programs, line 7c, and subsidized health services, line 7g, were obtained from EPSi analytical reports. Community health improvement services, line 7e, Health professions education, line 7f, and cash and in-kind donations, line 7i were compiled using actual costs recorded in the CBISA software.
Part II, Community Building Activities: Avera Queen of Peace Hospital provided donations to various organizations to support activities as listed on Part II.
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 Queen of Peace 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: Health care needs are assessed through various methods. Given Mitchell is a regional center/hub and the sixth largest city in South Dakota, Avera Queen of Peace is integrally involved with community organizations, universities/colleges, schools, state programs and local governments. The next largest hospital offering the same level of services is 72 miles from Mitchell and most of the towns within our region have a population of less than 2,000. By working with all in our region, we are able to determine health needs and provide programs and solutions where possible. In addition to activities reported in the Community Health Needs Assessment, Avera Queen of Peace, Avera Weskota and Avera De Smet collaborate with a community health committees within their respective community to assess and promote health related matters.
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 Queen of Peace is a 50-bed hospital in Mitchell, South Dakota. The primary service area is defined as Davison County, South Dakota. Mitchell is the county seat of Davison County. According to the U.S. Census Bureau Quick Facts 2021 data, the estimated population of Davison County as of July 1, 2021 is 19,878 and is predominately white at 91.9%. It is estimated that 19.9% of the population is 65 years and over. The median household income is $48,267 with a 10.7% poverty rate. Uninsured individuals under age 65 is estimated at 11.6%.
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 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.
Part VI, Line 5: Avera Queen of Peace is a State Certified Level #4 Community Trauma Center and operates an emergency department staffed 24 hours per day with board certified physicians. Emergency care is provided on an open door basis regardless of ability to pay. Avera Queen of Peace leases two critical access hospitals which provide a broad range of inpatient, outpatient services and 24 hour emergency rooms in two very rural communities.Similar to the hospitals in the Avera Queen of Peace region, the clinics are operated on an open door basis and care is provided regardless of ability to pay.Medical staff privileges are extended to all licensed and qualified applicants. The Avera Queen of Peace Board of Directors is principally comprised of community members from the primary and secondary services areas. Members come from a variety of backgrounds including banking, education, agriculture, healthcare and private industry.
