4A (Expenses $ 9304194 including grants of $ 168) (Revenue $ 12427536)
ST. MICHAEL'S HOSPITAL, INC. (SMH) OPERATES A 25-BED CRITICAL ACCESS HOSPITAL WITH PROVIDER BASED RURAL HEALTH CLINICS LOCATED IN TYNDALL AND IN AVON. PROVIDER STAFF, NURSING PERSONNEL, LABORATORY AND RADIOLOGY PERSONNEL ARE AVAILABLE AS NEEDED 24-HOURS A DAY, 7-DAYS A WEEK. DURING THE FISCAL YEAR ENDING JUNE 30, 2022, ACUTE PATIENT DAYS WERE 314 AND SWING-BED DAYS WERE 1,007.SMH ENGAGED IN DISASTER ASSISTANCE DURING THE YEAR BY PROVIDING A COVID-19 VACCINATION CLINIC.

ST. MICHAEL'S HOSPITAL, INC.
PART V, SECTION B, LINE 5: SMH HELD FOCUS GROUPS IN THE FALL OF 2021, IN-PERSON ONE ON ONE CONVERSATIONS AND AN ELECTRONIC SURVEY FEBRUARY & MARCH 2022. GROUPS AND INDIVIDUALS WERE CHOSEN TO PARTICIPATE BASED ON BEING A MEMBER OF THE COMMUNITY THE HOSPITAL SERVES AND/OR BEING A PROVIDER OF SERVICES TO THE COMMUNITY IN SOME CAPACITY. VARIOUS INDIVIDUALS, AS WELL AS REPRESENTATIVES FROM BON HOMME AND AVON SCHOOLS, MINISTERIAL ASSOCIATION, FOOD PANTRY, BON HOMME COUNTY HEALTH NURSE, BARGAIN SHOPPE, CHAMBER OF COMMERCE, MIKE DURFEE STATE PRISON, EMS, FIRE DEPARTMENTS, NURSING HOME, SENIOR CITIZENS, BOARD MEMBERS, MEDICAL STAFF AND EMPLOYEES WERE ENGAGED AND PROVIDED INPUT.

ST. MICHAEL'S HOSPITAL, INC.
PART V, SECTION B, LINE 11: AS PART OF THE CHNA COMPLETED IN 2021, THE COMMITTEE DISCUSSED THE DATA GATHERED AND CAME TO A CONSENSUS, RANKING THE HEALTH NEEDS AND FOCUS AREAS FOR THE COMMUNITY AS FOLLOWS:1. HEALTHCARE ACCESS FOR BON HOMME COUNTY, RECRUITMENT OF ADDITIONAL FAMILY PRACTICE PHYSICIAN.2. CONTINUE EFFORTS FROM THE PREVIOUS CHNA BY ADDRESSING PHYSICAL INACTIVITY IN OUR SERVICE AREA. ACTION PLANS HAVE BEEN DETAILED TO SOLVE THE NEEDS IDENTIFIED IN THE CHNA.1. HEALTHCARE ACCESS FOR BON HOMME COUNTY, RECRUITMENT OF ADDITIONAL FAMILY PRACTICE PHYSICIAN. A. WITH THE BOARD DIRECTION, SUPPORT, AND ENGAGEMENT, WORK WITH AVERA'S PHYSICIAN RECRUITER TO IDENTIFY WORKLOAD TO SUPPORT OUR RECRUITMENT EFFORTS.B. EXPLORE THE USE OF A RECRUITMENT COMPANY TO IMPROVE OUR EFFORTS.C. ENGAGE MEDICAL STAFF IN THE RECRUITMENT PROCESS.D. COMMUNITY ENGAGEMENT IN HIRING AND ONBOARDING PROCESS.E. ADDITIONAL STEPS TO BE DETERMINED AS THE PROCESS IS UNDERWAY.2. CONTINUE EFFORTS FROM THE PREVIOUS CHNA BY ADDRESSING THE PHYSICAL INACTIVITY IN OUR SERVICE AREA. A. EDUCATE COMMUNITY ON INCIDENCE OF DISEASE IN COUNTY AND ITS RELATION TO PHYSICAL INACTIVITY. POTENTIAL EDUCATIONAL OFFERINGS: SMH WOMEN'S NIGHT, DIABETIC EDUCATION, WELLNESS CENTER CLASSES, DISCHARGE PLANNING, EMPLOYEE WELLNESS CHALLENGES, ETC.B. ENGAGE COMMUNITY GROUPS AND EMPLOYEES IN EDUCATION AND PROGRAMMING EFFORTS. GROUPS TO COLLABORATE WITH: OTHER COMMUNITY FITNESS CENTERS, CIVIC GROUPS, LOCAL BUSINESSES, SCHOOL DISTRICT EVENTS AND SPORTS, ETC. C. UTILIZE EXISTING PROGRAMS AND SERVICES TO BUILD IN PREVENTATIVE EDUCATION AND PHYSICAL ACTIVITY. THESE PROGRAMS AND SERVICES INCLUDE PLANET HEART, OSTEOPOROSIS STRENGTH CLASS, PHARMACY CONSULTS, FOOT CLINIC, ETC. D. PREVENTATIVE PROGRAM FOCUS WOULD INCLUDE OBESITY, CARDIOVASCULAR DISEASE, AND DIABETES. IN THE CURRENT YEAR ST. MICHAEL'S HOSPITAL HAS BEGUN WORKING WITH A RECRUITMENT COMPANY AND AVERA'S PHYSICIAN RECRUITER AND HAS CONTINUED WITH EFFORTS TO INCREASE EDUCATION AND PROMOTE PROGRAMS AND SERVICES TO ADDRESS PHYSICAL INACTIVITY IN OUR SERVICE AREA.DUE TO RESOURCE CONSTRAINTS, THE OTHER PRIORITY AREAS OF BEHAVIORAL HEALTH, DIABETES PREVALENCE AND OBESITY ARE NOT THE MAIN FOCUS AND WOULD NATURALLY BE CONDUITS OF IMPROVED OUTCOMES BASED ON THE TWO PRIORITY TOPICS CHOSEN.

ST. MICHAEL'S HOSPITAL, INC.
PART V, SECTION B, LINE 13H: PRESUMPTIVE ELIGIBILITY IS UTILIZED AS A LAST RESORT.

ST. MICHAEL'S HOSPITAL, INC.
PART V, SECTION B, LINE 16J: A SUMMARY OF THE FINANCIAL ASSISTANCE POLICY IS POSTED IN THE EMERGENCY ROOM, RECEPTION AREA AND WAITING AREAS. STAFF DISCUSS THE AVAILABILITY OF THE FACILITY'S FINANCIAL ASSISTANCE POLICY WITH PATIENTS DURING THEIR STAY. NOTICE IS ALSO INCLUDED IN PAYMENT REMINDER LETTERS AND IN STATEMENTS.

ST. MICHAEL'S HOSPITAL, INC.
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, LINE 7A
THE COMMUNITY HEALTH NEEDS ASSESSMENT IS AVAILABLE AT HTTPS://WWW.AVERA.ORG/ABOUT/COMMUNITY-HEALTH-NEEDS-ASSESSMENTS/#MICHAEL

PART V. SECTION B, LINE 10A
THE IMPLEMENTATION STRATEGY IS AVAILABLE UPON REQUEST AND ATHTTPS://WWW.AVERA.ORG/ABOUT/COMMUNITY-HEALTH-NEEDS-ASSESSMENTS/#MICHAEL

PART I, LINE 3C:
IN ADDITION TO THE USE OF FPG TO DETERMINE ELIGIBILITY FOR FREE OR DISCOUNTED CARE, SMH ALSO LOOKS AT THE PATIENT'S MEDICAL INDIGENCY, INSURANCE STATUS AND ELIGIBILITY FOR MEDICARE/MEDICAID. BEING IN A RURAL COMMUNITY WITH A SMALL POPULATION, SMH MAY ALSO USE KNOWN INFORMATION OF A PATIENT'S HARDSHIPS IN MAKING THE FINAL DETERMINATION. PRESUMPTIVE ELIGIBILITY IS UTILIZED AS A LAST RESORT.

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. LINES 7E, 7F, AND 7I WERE OBTAINED UTILIZING THE ACTUAL GENERAL LEDGER SYSTEM. LINE 7G WAS OBTAINED FROM THE MEDICARE COST REPORT.

PART I, LINE 7G:
PHYSICIAN CLINIC COSTS ARE INCLUDED IN SUBSIDIZED HEALTH SERVICES. REVENUES OF $816,133 AND COSTS OF $1,448,583 WERE INCLUDED FOR A NET COMMUNITY BENEFIT OF $632,450.

PART II, COMMUNITY BUILDING ACTIVITIES:
SMH IS INVOLVED WITH THE AREA CHAMBER OF COMMERCE AND ROTARY CLUB. SMH WORKS TO ENHANCE THE QUALITY OF LIFE AND EMPOWER ITS PATIENTS, CARE-GIVERS AND COMMUNITY WITH THE RESOURCES THEY NEED WHEN THEY NEED THEM. SMH ALSO PROVIDES HEALTHCARE CAREER EDUCATION TO PROMOTE HEALTHCARE CAREERS AND RURAL HEALTH.

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 THIS CLASS OF PATIENTS.

PART III, LINE 3:
THE ESTIMATED AMOUNT OF THE ORGANIZATION'S IMPLICIT PRICE CONCESSIONS ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER THE ORGANIZATION'S CHARITY CARE POLICY IS CALCULATED BASED ON THE PERCENTAGE OF INDIVIDUALS LIVING BELOW THE POVERTY LEVEL IN 2021. THEREFORE, 14% OF IMPLICIT PRICE CONCESSIONS CAN REASONABLY BE CONSIDERED A COMMUNITY BENEFIT AS IT WOULD HAVE BEEN WRITTEN OFF TO CHARITY CARE.

PART III, LINE 4:
THE FOOTNOTE THAT DESCRIBES IMPLICIT PRICE CONCESSIONS IS ON PAGES 9-10 OF THE ATTACHED AUDITED FINANCIAL STATEMENT.

PART III, LINE 8:
MEDICARE ALLOWABLE COST OF CARE WAS CALCULATED FROM THE MEDICARE COST REPORT FOR FISCAL YEAR ENDING 6/30/22. MANY PATIENTS IN OUR SERVICE AREA QUALIFY FOR MEDICARE. THE FACILITY PROVIDES SERVICES TO THESE PATIENTS EVEN THOUGH MEDICARE REIMBURSEMENT IS NOT SUFFICIENT TO COVER THE COST OF PROVIDING THIS CARE. PROVIDING SERVICES TO THIS POPULATION PROMOTES ACCESS TO HEALTHCARE SERVICES WHICH ARE NEEDED IN OUR COMMUNITY, THEREBY PROVIDING A BENEFIT TO OUR COMMUNITY.

PART III, LINE 9B:
SMH PROVIDES CARE TO PATIENTS WHO MEET CERTAIN CRITERIA UNDER ITS CHARITY CARE POLICY WITHOUT CHARGE OR AT AMOUNTS LESS THAN ITS ESTABLISHED RATES. THE HOSPITAL DOES NOT PURSUE COLLECTIONS OF AMOUNTS DETERMINED TO QUALIFY AS CHARITY CARE.

PART VI, LINE 2:
IN ORDER TO DETERMINE NEEDS OF THE COMMUNITY WE SERVE, ST. MICHAEL'S HOSPITAL CONDUCTS PATIENT SURVEYS VIA TELEPHONE THROUGH HEALTHSTREAMS, AND OUR PROVIDERS HAVE MONTHLY MEETINGS FOR CLINIC AND MEDICAL STAFF AT WHICH TIME MAY DISCUSS NEEDS THAT ARE IDENTIFIED THROUGH THE SURVEYS AND THROUGH OFFICE VISITS.

PART VI, LINE 3:
THE SMH STAFF ASSISTS PATIENTS WHO MAY BE ELIGIBLE FOR FINANCIAL ASSISTANCE BY DISCUSSING THE AVAILABILITY OF VARIOUS GOVERNMENT BENEFITS, SUCH AS MEDICAID OR STATE PROGRAMS, AND ASSISTING THE PATIENT WITH QUALIFICATION FOR SUCH PROGRAMS WHERE APPLICABLE. THE PROGRAMS ARE DISCUSSED DURING THEIR STAY AND PATIENT REQUEST. POSTERS HIGHLIGHTING VARIOUS ASSISTANCE OPTIONS (I.E. ALL WOMEN COUNT) ARE POSTED IN THE ADMISSION AREA. SMH STAFF ALSO DISCUSS THE AVAILABILITY OF ITS CHARITY CARE POLICY WITH PATIENTS DURING THEIR STAY.

PART VI, LINE 4:
SMH SERVES A RURAL POPULATION IN BON HOMME COUNTY WHICH INCLUDES THE CITIES OF TYNDALL, AVON, TABOR AND SPRINGFIELD. THERE IS ONE OTHER HOSPITAL IN BON HOMME COUNTY LOCATED IN SCOTLAND. THE POPULATION ESTIMATES AS OF JULY 2022 REPORT 7,014 PEOPLE WITH 14% OF THE POPULATION AT POVERTY LEVEL IN BON HOMME COUNTY. 10.2% OF BON HOMME COUNTY'S POPULATION IS AGE 65 OR OLDER, COMPARED TO THE 17.5% IN THE STATE OF SOUTH DAKOTA.

PART VI, LINE 5:
SMH'S GOVERNING BODY IS COMPRISED OF PERSONS WHO RESIDE IN BON HOMME COUNTY WHO ARE NEITHER EMPLOYEES NOR CONTRACTORS OF THE ORGANIZATION, NOR FAMILY MEMBERS THEREOF. THE ORGANIZATION EXTENDS MEDICAL STAFF PRIVILEGES TO ALL QUALIFIED PHYSICIANS IN ITS COMMUNITY FOR SOME OR ALL OF ITS DEPARTMENTS. SMH APPLIES SURPLUS FUNDS TO IMPROVEMENTS IN PATIENT CARE AND PROVIDES READILY ACCESSIBLE HEALTH CARE TO THE PEOPLE OF BON HOMME COUNTY AND THE SURROUNDING AREA.SMH PROVIDES A VARIETY OF COMMUNITY BENEFIT HEALTH ACTIVITIES AT NO COST OR LESS THAN COST. THESE ACTIVITIES INCLUDE WELLNESS PROGRAMS, NUTRITION EDUCATION, FOOT CLINICS, CPR CLASSES, AND BLOOD PRESSURE SCREENINGS. A VARIETY OF PROGRAMS ARE PROVIDED AT NO CHARGE FOR THE CHILDREN IN OUR COMMUNITIES SUCH AS THE IMPACT CONCUSSION PROGRAM, FLU SHOT CLINICS, AND ATHLETIC SCREENINGS. SMH ALSO PROVIDES ATHLETIC PHYSICALS FOR STUDENTS AT A DISCOUNTED RATE. SMH PROVIDES A NURSE ON AN AS NEEDED BASIS FOR AMBULANCE TRANSFERS AT NO COST TO THE LOCAL AMBULANCE SERVICE. APPROXIMATELY 12 CLIENTS WERE SERVED DURING THE FISCAL YEAR ENDED 6/30/22 FOR AMBULANCE TRIPS.SMH PROVIDED FINANCIAL AND IN KIND DONATIONS FOR VARIOUS COMMUNITY NEEDS SUCH AS MEETING ROOM AVAILABILITY, MEDICAL STAFF COVERAGE AT LOCAL SPORTING EVENTS, AND HEALTH EDUCATION, INCLUDING HEALTH PROFESSION EDUCATION FOR STUDENTS GOING INTO THE HEALTHCARE FIELD. SMH PROVIDES EMERGENCY SERVICES 24-HOURS A DAY, 7-DAYS A WEEK. IN ADDITION TO NURSING STAFF, A MIDLEVEL PROVIDER AND/OR PHYSICIAN ARE IN HOUSE OR ON CALL AT ALL TIMES TO PROVIDE CARE TO ANYONE PRESENTING WITH AN EMERGENT CONDITION REGARDLESS OF THEIR ABILITY TO PAY. FOR FISCAL YEAR ENDED 6/30/22, THERE WERE 746 PATIENTS WHO RECEIVED EMERGENCY CARE AT SMH. SMH ALSO MAKES AVAILABLE E-EMERGENCY SERVICES THROUGH AN ARRANGEMENT WITH AVEL ECARE WHEREBY EMERGENCY PHYSICIANS AND OTHER SPECIALISTS ARE AVAILABLE VIA VIDEO CONFERENCING TO ASSIST THE MEDICAL STAFF AND NURSES WITH PATIENTS PRESENTING TO THE SMH EMERGENCY ROOM. THE E-EMERGENCY SERVICES ARE PROVIDED AT NO COST TO THE PATIENT. 32 PATIENTS BENEFITED FROM THE E-EMERGENCY SERVICES DURING THE FISCAL YEAR ENDED 6/30/2022.

PART VI, LINE 6:
"SMH IS A MANAGED FACILITY OF AVERA HEALTH. AVERA HEALTH AND THE HOSPITAL WORK COOPERATIVELY TO ENHANCE HEALTHCARE THROUGHOUT THE COMMUNITY SERVED BY SMH. SMH ALSO HAS ACCESS TO ""BACK OFFICE"" SUPPORT SERVICES, SUCH AS LEGAL CONSULTATION, QUALITY BENCHMARKING, CODING, COMPUTER SERVICES, CONTRACT NEGOTIATIONS, ADMINISTRATIVE CONSULTATION, GROUP PURCHASING, HUMAN RESOURCES ASSISTANCE AND MANY OTHER SERVICES. AVERA HEALTH IS ABLE TO PROVIDE THESE SERVICES TO SMH AT A COST BELOW THAT WHICH THE HOSPITAL COULD OTHERWISE ACHIEVE. IN TURN, LOCAL CAREGIVERS ARE ABLE TO DEVOTE MORE RESOURCES TO PATIENT CARE. AVERA HEALTH AND SMH DEDICATE RESOURCES TO ENDEAVORS THAT MAKE A POSITIVE DIFFERENCE TO IMPROVE THE HEALTH OF THE COMMUNITIES THEY SERVE. THESE ACTIVITIES INCLUDE LEADERSHIP DEVELOPMENT AND TRAINING FOR COMMUNITY MEMBERS, ECONOMIC DEVELOPMENT, PHYSICAL IMPROVEMENTS IN THE COMMUNITY, CONTRIBUTIONS TO NONPROFIT COMMUNITY ORGANIZATIONS, NONPROFIT EVENT SPONSORSHIPS, DONATED MEDICAL SUPPLIES, COMMUNITY HEALTH EDUCATION AND SUPPORT GROUPS, HEALTH SCREENINGS, FLU-SHOT CLINICS, COMMUNITY HEALTH EDUCATION AND VARIOUS OTHER ACTIVITIES."