4A (Expenses $ 189434761 including grants of $ 193606) (Revenue $ 202257348)
Avera St. Luke's mission is to provide healthcare services to Aberdeen, South Dakota residents and residents of the surrounding area. Avera St. Luke's is a 501(c)(3) organization affiliated with Avera Health. Avera St. Luke's consists of 50 acute beds, 10 inpatient behavioral health beds, an 81 bed nursing home in Aberdeen, SD, a 56 bed nursing home in Eureka, SD, a 2-bed surgical center in Aberdeen, SD, and 16 physician clinics. The physician clinics include primary care, ob/gyn, pediatrics, orthopedics, general surgery, radiation, radiology, oncology, therapy, neurology, urology, hematology, psychiatry, neonatology, gastroenterology, and cardiology. Avera St. Luke's provides acute care and long-term healthcare services. Avera St. Luke's Hospital3,336 Acute patient discharges360 Newborn patient discharges43 Swing bed patient discharges123,579 Outpatient visits561 Swing-bed patient days603 Newborn patient days150,529 Clinic visits43,939 Nursing home resident days104 Long Term Care patient dischargesAvera St. Luke's 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 $3,758,750.Avera St. Luke's also provides community benefit health activities at less than or at no cost to support those in the area served, see Schedule H. As a member of the Avera Health Network, Avera St. Luke's 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 St. Luke's 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 St. Luke's
Part V, Section B, Line 5: Avera St. Luke's CHNA data was obtained by way of an online survey that launched on April 7, 2022. This was followed by personal meetings with our Public Health providers, as well as emails and communications to regional and community organizations and the general public inviting their participation in the survey. The survey was also posted to and available through Avera St. Luke's Facebook page. The survey closed April 15, 2022. The hospital invited a vast array of groups and approximately 80 businesses in Aberdeen and the surrounding area to participate, which included: *Aberdeen Chamber of Commerce, which included the survey in their Monday morning Chamber email *Aberdeen Chamber committees *Aberdeen Area Fire And Rescue *Social Work Department, which sent the survey to all the organizations and food banks they work with such as the Salvation Army and Journey Home*Mission and Chaplaincy, which forwarded on to all area priests in our region *Boys and Girls Club families *United Way, which sent it to organizations and board members *Aberdeen City Council *City of Aberdeen via its Human Resource Department *Brown County Health*ASL employees *ASL Facebook page, which is open to the public *ASL Patient and Family Advisory Committee *Presentation Sisters*Aberdeen Area Diversity Coalition

Avera St. Luke's
Part V, Section B, Line 11: An internal team at Avera St. Luke's reviewed survey results and identified the top three health needs from the survey. This decision was based on the severity of the issue, our current involvement in these areas, and our professional outlook. Our overall focus is to review these opportunities and identify current programs already in place that will address the following health needs: Mental Health issues, Hospice and End of Life Care, and Access to Care/Urgent Care. 1. Mental Health: Avera St. Luke's has announced a significant investment in our region, which includes a stand-alone behavioral health facility and access to emergency mental health care. 2. Hospice Care: A multi-disciplinary team has been created to take a deeper look into hospice needs in our region. That team will report their findings to our Administration and Board of Directors. 3. Access to Care/Urgent Care: It's likely that the results of this survey were affected by the limited access to care and urgent care during the COVID-19 pandemic. At times, our Urgent Care was not available. Patients also stopped seeking routine care, and many of our resources were reallocated to serve an influx of COVID-19 patients. However, with a decrease in COVID-19, we have been able to reestablish set hours for our Urgent Care and Primary Care Providers. Patients will have access to emergency mental health care with the opening of a new stand-alone behavioral health facility, projected to open in 2024. A donation to Avera Health will help revitalize and update our emergency department within the next few years. It remains important that current and prospective patients know how to access care and which level of care to access. Avera St. Luke's continued to address the three prioritized needs resulting from the 2018 Community Health Needs Assessment: Preventative Care and Removing Barriers to Health Needs, Health Care Affordability, and Transportation Needs.Preventive Care and Removing Barriers to Health Needs:FY2022 Update:The COVID-19 pandemic often led us to focus on other community health needs like staying healthy, masking, and getting vaccinated. But with this, we helped to remove barriers to ensure our community had access to COVID-19 resources and materials by providing masks to area schools and nonprofits, providing otherwise hard to find thermometers to local schools, and hosting several vaccination clinics, sometimes even meeting people where they already were (i.e. Arts in the Park, Northern State University and Presentation College, area business partners, etc.). Avera St. Luke's administered tens of thousands of vaccines and had great success with educating the community on the importance of being vaccinated. COVID-19 also led to a huge increase in patients for Avera at Home, a true way to keep patients in their home and meet them where they were. We also began our Home to Hotel program, partnering with MyPlace Hotels. With this, surgical patients were discharged to MyPlace for an overnight stay. It allowed them the comfort of being close the hospital without being an inpatient. We update our 211 helpline information annually (and as needed) to ensure the community has access to all areas of life assistance and quality health programs.Health Care Affordability:FY2022 Update: Social workers continue to assist patients on navigation through Medicare, Medicaid, Disability and insurance exchange programs. Access and navigation assistance to medication programs and medical equipment needs are also available. Since navigating surges in positivity rates and hospitalization throughout the COVID-19 pandemic, we have been able to once again focus on preventative care, offering a series of screenings, encouraging annual wellness checks, and prioritizing other preventative care measures. Preventative care can help reduce the cost of emergency care or the care of chronic or serious diseases and conditions through early diagnosis. ACO's continue to reduce in-patient hospital stays and prevent a lower incident of further developing chronic disease. In January 2021, the Centers for Medicare and Medicaid Services (CMS) began to require hospitals to provide a price estimator tool. Thus, Avera is proud to be a leader in providing consumers with easily accessible, understandable and reliable information about health care costs. We offer an online tool to let consumers compare price estimates for a wide range of health care services. We've also worked to develop a brochure and communication that helps patients understand where to receive care depending on their health concern/issue/levels of crisis. The goal remains to decrease unnecessary costs for health care needs that can be handled when individuals go to the proper location.Transportation Needs:FY2022 Update:With the help of the Avera Foundation, the Avera Cancer Institute Aberdeen, and our Wound Care department, we provided gas cards and Ride Line punch cards to those needing transportation assistance. We also paid some transportation bills. As mentioned above, our Home to Hotel program also kept surgical patients close to the hospital without the cost of a night's stay, and without needing to drive home and back for a next day appointment.

Avera St. Luke's
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 St. Luke's
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 is included in the billing statement. In addition, the financial assistance policy is discussed with the patient upon admission to the facility.

Avera St. Luke's
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 St. Luke's
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:
avera.org/locations/st-lukes-hospital/

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

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 methodologies were used to calculate the amounts reported in the table. A cost-to-charge ratio derived from Worksheet 2, ratio of patient care cost-to-charges was used to calculate charity care at cost, unreimbursed Medicaid and Means-Tested Government Program expenses. Subsidized health was calculated based on actual cost/loss. For all other amounts, costs and revenues as reflected by the general ledger system were used.

Part II, Community Building Activities:
NATIONAL NIGHT OUT - National Night Out is an annual community-building campaign that promotes police/community partnerships and neighborhood comaraderie to make our neighborhoods safer, more caring places to live. National Night Out enhances the relationship between neighbors and law enforcement. Our local sponsor, the Aberdeen Police Department, invites local organizations to participate each year in this event held on the first Tuesday of August at Melgaard Park. A free meal is served by volunteers from many organizations and entertainment is offered to all free of charge. Avera St. Luke's participated in the event on August 3, 2021 by offering a booth with games and prizes with our focus on child safety. The event brings out around 1,500 to 2,000 children and families for a fun evening.ASPIRE/SD DEPT OF VOC REHAB - Project SEARCH provides internships for high school students with disabilities in their last year of high school and assists in helping students attain work skills and prepare them for a job. Students chosen for the program are ready to join the workforce and do not have plans to go to college but have skills that would enable them to be gainfully employed. We want to assist in meeting the community workforce needs as well as help these students obtain employment vs. being on federal assistance. Avera St. Luke's donated to the Aberdeen Park and Recreation Board. The donation was used to build an all-inclusive, handicap-accessible playground inside Storybook Land. The new playground was named after Nano Nagle, the founder of the Presentation Sisters. The playground will give all children a place to play together.Through the Avera Human Performance Center, athletic trainers offer high quality sports medicine care to regional school districts by assisting student athletes with acute injuries or rehabilitating chronic sprains and strains. Athletic trainers are provided to the school district as an extension of the athletic department through a sports medicine partnership with Avera St. Luke's.Because solid community partnerships are important, Avera has committed $80,000 over four years to the Boys and Girls Club of Aberdeen Area. Many of Avera St. Luke's employees utilize the services the club offers which means this gift will not only greatly benefit the community but also our own workforce. In fact, Avera is the largest employer in the Aberdeen area using the club's after school program services. The donation will assist the Boys and Girls Club to help grow its membership and programming capability to its pre-COVID numbers through scholarships.

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 St. Luke's 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 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 2:
Health Care needs are assessed through various methods. Given Aberdeen is a regional center/hub and the third largest city in South Dakota, Avera St. Luke's is integrally involved with community organizations, universities/colleges, schools, state programs and local governments. Although another smaller hospital opened in Aberdeen during FY 2013, the next largest hospital is 100 miles from Aberdeen, 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. Our fourth community health needs assessment (CHNA) was completed and posted to our website by June 30, 2022. The identified areas of need highlighted for further research and comparison are Mental Health issues, Hospice and End of Life Care and lastly Access to Care/Urgent Care. The overall goal is to focus on removing all barriers to health.

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 St Luke's includes a 50-bed hospital and a 10-bed mental health unit in Aberdeen, South Dakota. The primary service area is defined as Brown County, South Dakota, including the communities of Aberdeen, Frederick, Groton, Hecla, and Leola. Brown County is the focus of the Avera St. Luke's Community Health Needs Assessment. The total population as of 2022 is 39,780, which places it as the fourth largest county in South Dakota. Brown County is also the most populated county in the Avera St. Luke's service area. 57% of residents served are between the ages of 18 and 64. 87% of Brown County's population consists of people who are of White Ethnicity. Brown County has seen an increase of people from other ethnic backgrounds. Because we are all created in God's image and belong to the same human family, Avera has worked hard to meet the growing need to address complex issues within our footprint. Through our system initiatives, Avera St. Luke's is committed to evaluating the health needs and priorities of all members of our community without regard to race or ethnicity. Programs and support are added to address the identified needs as appropriate. The unemployment rate in South Dakota is at 2.55% while the rate in Brown County is at 2.8%, both of which are better than the national average of 3.6%. According to the U.S. Census Bureau as of July 1, the income per capita for the county is $33,535 and the median household income is $61,816. However, the rate of persons below the poverty level in Brown County is 9.1%. Approximately 12.2% of the county's population is uninsured, while the State average is 15%. Although Brown County's numbers are slightly better than the state and national statistics in these categories, Avera has identified opportunities.

Part VI, Line 5:
Avera St. Luke's is a regional facility within Avera Health System. We are a health ministry co-sponsored by the Benedictine Sisters of Yankton, South Dakota and the Presentation Sisters of Aberdeen, South Dakota. Our health ministry is rooted in the Gospel and requires us to make a positive impact in the lives and health of persons and communities by providing quality services guided by Christian values. Avera St. Luke's vision is tobe an exceptional health care organization for patients to receive care, physicians to practice and employees to work. The Organization's values are Compassion, Hospitality and Stewardship. Our governing body consists of 15 members who are physicians, community and regional residents and Sister representatives from the Presentation and Benedictine Orders. In addition, the CEO serves on the board as a non-voting member. In addition to the governing body, we have one advisory board. This includes Northern State University Business School. Medical Staff privileges can be extended to qualified physicians based on receiving approval of their application and credentials by the Medical Staff and the Hospital governing body. The Hospital's governing body takes into account other factors related to overall community need and how a physician would impact the Hospital's overall ability to fulfill the mission. Avera St. Luke's mission and values ensure our focus is on the patient, family, employees, physicians, those in need, visitors and our region as a whole. The value of Stewardship requires the organization to use all resources in a way that fulfills the mission and values. Each year, our operating and capital budgets are based on various assumptions that in the end provide the needed resources and take into account charity care, patient care, technology, education, community services, employee benefit and compensation plans and programs for meeting the region's needs. All surplus funds are used and maintained to provide for both current and future needs.Specific examples of how we further our exempt purpose include but are not limited to the following:a. The only inpatient psychiatric unit within 200 milesb. Interventional Cardiology and Radiology services. These services allow us to meet patient needs when care is critical to their survival and must be delivered on a very timely basis.c. Air Ambulance to transport patients to our facility or 200 miles to tertiary facilities.d. End Stage Renal Disease program which serves our broad region with the next closest facility being 100 miles away. Additionally, we employ a full-time Nephrologist to care for the patients along with others who require intensive physician care.e. A 24 hour Emergency Room which treats all patients without regard to the ability to pay. The ER is staffed by physicians 24 hours per day.f. Provision of a multitude of educational and training programs for healthcare professionals and regional residents. The region was awarded an Area Health Education Center by the South Dakota School of Medicine and will be located in Aberdeen. The award was based on applications and interviews within the State and was a collaborative effort of many healthcare and non-healthcare organizations within the region with two being 100 miles from Aberdeen.g. Avera St. Luke's is currently a Rural Referral Center. The nearest hospitals are tertiary facilities 200 miles away by ground and approximately 140 miles by air.h. Avera St. Luke's participates in many community organizations and efforts to better the region. Leadership of the organization is on boards of many exempt organizations (College/University Advisory Boards, Marshall County Health Center, Chamber of Commerce, Area Health Education Center (AHEC), United Way and the YMCA). Other community involvement includes the Sertoma Club, Junior Achievement, Northern Brown County Community Foundation, Diversity Committee, Aberdeen Hockey Association, American Foundation for Suicide Prevention and CoJourner for the Presentation Sisters (Lay Associate).i. Provide assistance to small rural hospitals (Critical Access Hospitals) within the region through various programs, management agreements, computer systems, education and other services to assist in keeping theirarea's patients in the local community when possible.j. Recruitment of specialists in nephrology, neurology, cardiology and psychiatry to meet the region's need in order to eliminate travel of 200 miles to obtain these services.k. Development and subsidy of various rural clinics to meet needs in those communities.l. Chemical Addiction services on an outpatient basis are provided to the region and State. Our Addiction Care program is well known and respected within the region and state and is the closest program within 150-200miles. We contract with the State for patients who meet their qualification guidelines and work with governmental agencies within the region and State.m. Provide drug and alcohol prevention programs to the local schools through various contracts. Our involvement started when the previous provider discontinued their contract.