Community Benefit Insight - Tax-exempt hospital

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St Benedict Health Center

Avera St Benedict Health Center

401 West Glynn Drive
Parkston, SD 57366

Bed count	25	Medicare provider number	431330	Member of the Council of Teaching Hospitals	NO	Children's hospital	NO

EIN: 460226738

Display data for year:

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

1.54%

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	$ 102,316 0.44 %
Medicaid as % of operating expenses	$ 29,513 0.13 %
Costs of other means-tested government programs as % of operating expenses	$ 11,935 0.05 %
Health professions education as % of operating expenses	$ 18,000 0.08 %
Subsidized health services as % of operating expenses	$ 67,735 0.29 %
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.	$ 87,971 0.38 %
Cash and in-kind contributions for community benefit* as % of operating expenses	$ 39,964 0.17 %
Community building* as % of operating expenses	$ 56,325 0.24 %

* = 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	$ 56,325 0.24 %
Physical improvements and housing as % of community building expenses	$ 0 0 %
Economic development as % of community building expenses	$ 47,030 83.50 %
Community support as % of community building expenses	$ 9,295 16.50 %
Environmental improvements as % of community building expenses	$ 0 0 %
Leadership development and training for community members as % of community building expenses	$ 0 0 %
Coalition building as % of community building expenses	$ 0 0 %
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	$ 718,816 3.11 %
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 2022 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 $ 20458683 including grants of $ 81741) (Revenue $ 27690537)
Avera St. Benedict Health Center's (Avera St. Benedict) mission is to provide healthcare services to Parkston, Tripp and Lake Andes, South Dakota residents and residents of the surrounding area. Avera St. Benedict is a 501(c)(3) organization affiliated with Avera Health. Avera St. Benedict consists of a 25-bed critical access hospital, a 49-bed nursing home, a 25-bed assisted living center and three provider based clinics. Services offered by Avera St. Benedict include primary care, emergency, general surgery, orthopedic surgery, podiatry surgery, cardiac rehab, pain management, pharmacy, behavioral health, laboratory, imaging, telemedicine, wellness center, speech therapy, physical therapy and occupational therapy. Avera St. Benedict provides acute care and long-term healthcare services.Following is a breakdown of these statistics by facility:Avera St. Benedict Hospital416 Acute patient discharges58 Newborn patient discharges147 Swing bed patient discharges16,574 Outpatient visits1,092 Swing-bed patient days88 Newborn patient days21,829 Clinic visitsAvera Bormann Manor16,725 Nursing home resident days25 Long Term Care patient dischargesAvera St. Benedict 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 $60,175.Avera St. Benedict 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 St. Benedict 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 St. Benedict 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.

St. Benedict Hospital Inc.
Part V, Section B, Line 5: A variety of individuals and groups of people were involved in the CHNA process from November 2021 through February 2022. Qualitative data was obtained from questionnaires and interviews with the Hutchinson County Community Health Nurse, Ministerial Association member, Trojen Den organizer, Parkston School District teacher and superintendent, local daycare provider, low income patient, local business representative, American Legion Post 194 representative, and a Hutterite Colony boss. Each of these were chosen to represent a cross section of the community and to adequately assess the needs of underserved populations. A survey (electronic and paper) was completed by 98 community members.

St. Benedict Hospital Inc.
Part V, Section B, Line 11: Identified health needs through the data gathering process were stratified into five broad categories to help prioritize areas and realistically choose options for the health center to address. The CHNA committee discussed the health needs identified during the community health needs assessment and prioritized the needs based on the following criteria:1. Estimated feasibility for the health care center to address the issue with current resources2. Importance the community placed on the need 3. Burden, scope, severity, or urgency of the health need4. Health disparities associated with the needThrough the assessment process, the following needs were determined to be of highest priority:*Cancer prevention screening*Improving access to care through better dissemination of resource materials*Accident prevention*Substance abuse/alcohol use preventionCancer prevention screening. The community feels there are some great resources in the service area, but there are gaps. Cancer prevention screening rates are below the state average and gaps were identified in meeting the needs of the community with cancer prevention screenings, especially with mammograms. Cancer prevention is an issue that potentially effects everyone in our service area. Lack of cancer prevention screening leads to health disparities and increased rates of mortality.Improving access to care through better dissemination of resource materials. Access to care includes being a resource for current community members and being able to reach new people that come to the service area. Providing resource packets to community members that help people navigate access to healthcare can help increase access to those in need by raising awareness. This was prioritized based on importance the community placed on the need and feasibility for the health center to address with current resources.Accident prevention. This was prioritized based on importance the community placed on the need and the health disparities associated with the need. Preventable accidents lead to higher costs of care and increased strain on emergency medical services. There are other organizations within the service area that can be partnered with to help address this need. Substance Abuse/Alcohol Use prevention. There were many concerns identified during the process regarding alcohol use and drug use in the community across the lifespan. Avera St. Benedict has the current infrastructure to integrate some elements of substance use prevention at no cost as a community benefit. Evaluation of impact of the community going without these services was discussed and how this would potentially leave a void in the community where feedback and data indicate substance use prevention is valued. Activities To Address significant needs:CANCER PREVENTION SCREENING*Implement better identification of, and opportunities to, screen for cancer prevention. *Implement and execute better patient identification and personalized contact to improve cancer screening rates in the service area.*Improve staff and community education on cancer screening opportunities through multiple different avenues.*Promote and utilize the All Women Count program to improve screening in women who qualify for the program.*Implement a cancer prevention health fair in conjunction with the annual cancer walk that takes place in Parkston, SD.*Work towards establishing a foundation account for cancer prevention.IMPROVING ACCESS TO CARE THROUGH BETTER DISSEMINATION OF RESOUCE MATERIALS*Increase community knowledge of how to access healthcare locally.*Create an ASB guide of healthcare services to be disseminated at City Hall so new community residents understand healthcare access locally.*Have an information booth at school registration on healthcare access.*Have healthcare access guides within the facility, including outreach sites.*Integrate community health into the care of newborns before and after OB deliveries, including before new parent(s) are discharged.*Utilize print media and social media to educate the service area on access to care issues.ACCIDENT PREVENTION*Avera St. Benedict will lead community partnerships to facilitate accident prevention in the service area.*Host a baby sitters clinic with safety elements such as how to access poison control.*Promote ways to have a safer community in areas such as agricultural safety, gun safety, water safety, bike safety, equine safety, grain bin safety, motor vehicle safety.SUBSTANCE ABUSE/ALCOHOL USE PREVENTION*Educate the community on substance use and alcohol use prevention.*Assist in a substance use prevention curriculum at school.*Educate parents on substance and alcohol prevention.*Promote local recovery access to groups such as Alcoholics Anonymous.*Create a resource on how to reach out for help with behavioral health needs such as, mental health, substance use or alcohol use.Significant Health Needs Not Addressed:When the Community Health Needs Assessment Committee met on June 29, 2022 to discuss goals and action plans for the significant health needs, there was also discussion on what needs identified would not be addressed. Lifestyle choices, poverty, and socioeconomic issues were all items of interest and assessed as a community need. As a health care organization, there are limits to what can be addressed regarding lifestyle choices, poverty, and socioeconomic issues. Due to feasibility, these issues will not be directly addressed. The previous community health needs assessment was completed in 2018. Action on the implementation plan has started or completed in most areas. COVID 19 impacted some of the activities by delaying or canceling them completely. Following are the community health priorities identified and actions taken.ObesityProvided scheduled free access to Avera St. Benedict's Wellness Center and provided Fitness on Demand classes. The facility also continues to provide Meals on Wheel to the community.Transportation and Access to CareFacility has promoted telehealth services to reduce transportation needs and to keep residents safe during pandemic. Continued to provide in-home medical care for those that do not have transportation, specifically in high risk populations.After School Activities for KidsDue to COVID 19 there was minimal movement on this.

St. Benedict Hospital Inc.
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.

St. Benedict Hospital Inc.
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.

St. Benedict Hospital Inc.
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.

St. Benedict 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.

Schedule H Part V, Section B, Lines 7a, 7b and 10a:
Community Health Needs Assessment and Implementation Strategy websiteavera.org/about/community-health-needs-assessments/#benedict

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

Schedule H Part V, Section A organization's website:
avera.org/locations/profile/avera-st-benedict-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. Unreimbursed Medicaid was calculated using the costing methods to prepare the cost report. Subsidized health services were calculated based on a combination of the Medicare cost report and an overall cost-to-charge ratio for certain expenses. Other means tested government programs, community health improvement services, health professions education, and cash and in-kind contributions are reported based on actual expenses recorded in the general ledger.

Part I, Line 7g:
Rural health clinic costs are included in subsidized health services. Revenues of $3,844,783 and costs of $3,849,344 were included for a net community benefit of $4,561.

Part II, Community Building Activities:
Avera St. Benedict Health Center 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 St. Benedict 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:
"Community needs are evaluated and assessed on an on-going basis in several ways. ASBHC has completed formal ""needs assessments"" several times over the course of the past several years. This has been accomplished with input from focus groups, surveys, short and long range planning by the Health Center Board, demographic and health care data analysis, regular meetings with the provider staff, and collaboration with the local school and churches, as well as local law enforcement."

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 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 4:
Avera St Benedict is a 25-bed critical access hospital in Parkston, South Dakota. The primary service area is defined as Hutchinson County, South Dakota, including the communities of Freeman, Menno, Olivet and Tripp. Olivet is the county seat. Agriculture is the primary economic driver in the county. In calendar year 2020, Avera St. Benedict had 422 inpatient discharges, 59.48% of inpatient discharges were from Hutchinson County (2020 South Dakota Association of Healthcare Organization Inpatient Origin and Destination Study). In fiscal year 2021, Hutchinson County produced 66% of total emergency department visits to Avera St. Benedict. According to the U.S. Census Bureau's 2020 data, the population of Hutchinson County was just over 7,400 people and is predominately White/Caucasian (95%). About 23% of the population is over the age of 65. County Health Rankings statistics assesses the unemployment rate of 3.1% compared with the state of South Dakota's 3.3% unemployment (2021.) County Health Rankings states that the median household income of Hutchinson County is $59,300, which is about $1,100 less than the state's average. The percentage of children in poverty in the county was projected at 17%, while about 9% of households being single parent households (2021). County Health Rankings rates high school graduation rates in the county at 88% and adults with some post-secondary education at 73% (2021). The secondary service area, including portions of Douglas, Davison, Bon Homme, Hanson and Charles Mix Counties are demographically similar to Hutchinson County with rural, agricultural lifestyles. In calendar year 2020, 38.87% of inpatient discharges were from one of these five counties (2020 South Dakota Association of Healthcare Organization Inpatient Origin and Destination Study). In fiscal year 2021, Douglas, Davison, Bon Homme, Hanson, and Charles Mix counties produced 25% of total emergency department visits to Avera St. Benedict. According to County Health Rankings and the US Census, Charles Mix County is different from the rest of the service area in that there is a 31.3% Native American population, median household income of $50,481, more children in poverty (30%) and children in single parent households (32%). Avera St. Benedict is the primary medical provider for 8 Hutterian Brethren Colonies in the primary and secondary service area, which includes about 550 individuals.

Part VI, Line 5:
The Organization's governing body is comprised of volunteer members who reside in the community. The Board of Directors meets monthly and has community representation that brings forward issues relative to challenges, needs and services within the community. The local ministerial group meets monthly at the Hospital and also identifies needs and gaps within the parishioners they serve. Medical staff privileges are extended to all qualified physicians in the community. The medical staff, including the physicians/mid-levels/department directors, has the opportunity to meet monthly and also discuss ways to meet the needs of the community they serve. Surplus funds are reinvested in facilities to improve patient care. The Hospital operates an emergency room that is available to all, regardless of ability to pay.ASBHC has a fitness center on campus that is available to help the community focus on wellness and prevention. This endeavor is subsidized by the facility to improve the health and well-being of the community as a whole. The chaplaincy mission services participate and spearhead many community projects including an angel tree at Christmas to address the needs of children in our service area. ASBHC also donates to the local food pantry and purchases, prepares, and serves a meal to the Love Feast in Mitchell, SD annually. The meal serves 300 plus people in need of nutrition. At that event, bags of groceries are provided to the families in need that are in attendance to take home. There are several other projects of this nature on a smaller scale at the local school system. ASBHC donates to community events such as American Cancer Society projects and sponsors health related educational programs to the community at large. Avera St. Benedict also provides medical, nursing, and other ancillary health professions the opportunity for hands on learning experiences through residencies, internships, clinical rotations and other shadowing and profession mentoring programs to help with students health care training needs.

Operating expenses	$ 23,139,136
Total amount spent on community benefits as % of operating expenses	$ 357,434 1.54 %