Composite
85.4 / 100 percentile
Screener / 435070
D
AVERA SISTER JAMES CARE CENTER
snfSD
2111 WEST 11TH STREET, YANKTON, SD 57078 · CCN 435070 · chain AVERA HEALTH
Peer group
snf n = 14,684
Evidence depth
deep
Certified beds
194
Model
v1.2
Reads as: riskier than 85.4% of the 14,684 facilities in the snf peer group. percentile within peer group, 100 = highest risk. Grade bands are fixed percentile cuts (F is the top 5% of peer risk), so a grade is a position, not an absolute level.
Score model4Components10CHOW radar1Distress radar1Staffing16Penalties0Deficiencies7Licensure0Ownership40Related party0Transactions0Comps12Market rent33
Composite explanation
4| Component | Percentile | Raw | Weight | Weight share | Contribution | Counts |
|---|---|---|---|---|---|---|
| billing conduct | 97.5 | 69.8 | 0.30 | 0.3000 | 29.25 | in index |
| staffing risk | 99.7 | 99.7 | 0.25 | 0.2500 | 24.93 | in index |
| regulatory risk | 18.6 | 12.1 | 0.30 | 0.3000 | 5.58 | in index |
| chow risk | 25.2 | 25.0 | 0.15 | 0.1500 | 3.78 | in index |
weighted_contribution sums to pre_rank_index over rows where counts_toward_index is true. The composite is the facility's percentile position of that index within its peer group, so contributions explain the input, and the rank explains the score.
Component scores and registry models
10| Score type | Score | Grade | Model | Status | Registry model notes |
|---|---|---|---|---|---|
| billing conduct | 69.8 | D | v0.1-pacpuf-snf | default · in composite | R22. PAC PUF SNF 2023. PDPM coding intensity vs acuity, stay length, charge markup. |
| chow risk | 25.0 | B | v0.1-pos | default · in composite | Change-of-ownership footprint in the CMS Provider of Services file: control-family, legal-name and address deltas across quarterly snapshots, plus certification reset recency and Medicare tenure. |
| p adverse action 12m | 0.6 | — | v0.1 | default · in composite | R23/W4-3. Deterministic logistic p(Medicare termination within 12m), SNF only. Label = first POS termination date (any code: voluntary closure, involuntary termination, merger exit); facilities already terminated by the panel date are excluded, not counted as safe. Trained on panels 2024-07/2024-10/2025-01 (n=46,466, 283 positives), evaluated on the held-out later panel 2025-04 BEFORE shipping: AUC 0.971, top-decile lift 9.5x, top-decile capture 95.4% of the 65 terminations that followed. Separability is high because closures announce themselves in the data: collapsing occupancy is the strongest signal, and the learned NEGATIVE weight on 12m deficiency counts is the surveys-stop signature of a facility winding down, not a claim that clean inspections are dangerous. Same 15 as-of-date features and anti-leakage chassis as p_chow_12m; SFF entry rejected as a label (only one month of SFF history exists, so as-of transitions cannot be reconstructed). Score = probability x 100; grade NULL. Not in any composite. |
| p chow 12m | 0.5 | — | v0.1 | default · in composite | R22/W4-2. Deterministic logistic p(CHOW within 12m), SNF only. Trained on panels 2024-07/2024-10/2025-01 (n=50,700, 1,207 positives), evaluated on the held-out later panel 2025-04 BEFORE shipping: AUC 0.874, top-decile lift 5.0x (top 10% of predictions captured 49.6% of the CHOWs that actually closed in the next 12 months). Shipped coefficients are the evaluated ones; no post-holdout refit. Caveat: holdout positives (133) run below the training base rate because recent CHOWs surface in public records with a lag, so measured lift is conservative. Features are as-of-date public records: PBJ staffing level/trend/contract share (quarterly history to 2022Q1), deficiency and CMP counts (12m), ownership tenure and churn from CHOW-evidenced transactions, beds, occupancy, ownership type, chain size. Chain membership and ownership type are current-state (history not published). SFF and star ratings deliberately excluded (no as-of history). Notable learned direction: long ownership tenure RAISES sale odds and a recent prior CHOW lowers them. Score = probability x 100; grade is NULL because a probability is not a quality letter. Not in any composite. |
| regulatory risk | 12.1 | A | v0.3 | default · in composite | Deficiency-based, SNF population. Runs alongside v0.5-pos. |
| staffing risk | 99.7 | F | v0.3 | default · in composite | Cost-report staffing, SNF population. Runs alongside v0.4-pos, which covers ICF/IID from POS. |
| regulatory risk | 12.0 | A | v0.1 | superseded | Pre-registry model iteration, superseded by a later regulatory_risk rebuild. Rows retained for audit per project convention (see regulatory_risk v0.4-pos); never consumed because v_cii_api_facility_score and the composite eligibility join both require status = default. Backfilled 2026-07-26 by alert triage on model_registry_integrity. |
| regulatory risk | 12.0 | A | v0.2 | superseded | Pre-registry model iteration, superseded by a later regulatory_risk rebuild. Rows retained for audit per project convention (see regulatory_risk v0.4-pos); never consumed because v_cii_api_facility_score and the composite eligibility join both require status = default. Backfilled 2026-07-26 by alert triage on model_registry_integrity. |
| staffing risk | 99.7 | F | v0.1 | superseded | Pre-registry model iteration, superseded by a later staffing_risk rebuild. Rows retained for audit per project convention (see regulatory_risk v0.4-pos); never consumed because v_cii_api_facility_score and the composite eligibility join both require status = default. Backfilled 2026-07-26 by alert triage on model_registry_integrity. |
| staffing risk | 99.7 | F | v0.2 | superseded | Pre-registry model iteration, superseded by a later staffing_risk rebuild. Rows retained for audit per project convention (see regulatory_risk v0.4-pos); never consumed because v_cii_api_facility_score and the composite eligibility join both require status = default. Backfilled 2026-07-26 by alert triage on model_registry_integrity. |
Rows with counts_toward_composite false come from models that are addressable or retracted rather than default. They exist and may be informative, but they did not enter the published composite and must not be summed as though they had.
CHOW radar — 12-month sale probability
full board →p(CHOW, 12m)
0.5%
model v0.1 · computed 2026-07-29
Percentile among SNFs
53.8
100 = most likely to sell
Holdout AUC
0.874
evaluated before shipping, never refit
| Driver | Value | Pull on odds | |
|---|---|---|---|
| For-profit ownership | 0.00 | -1.24 | |
| Occupancy | 0.97 | -0.80 | |
| Never sold on record | 1.00 | +0.62 | |
| Current owner tenure (years) | 25.00 | +0.57 | |
| No PBJ staffing report | 0.00 | +0.42 | |
| Total nurse staffing (HPRD) | 1.25 | +0.36 | |
| Chain size (log) | 3.37 | +0.31 | |
| Ownership changes, last 5 years | 0.00 | +0.20 |
p_adverse_action_12m: probability the facility's Medicare participation terminates within 12 months (any POS termination code; already-terminated facilities are excluded, not scored safe). Deterministic logistic over as-of-date public records, SNF only. Holdout (2025-04 panel, evaluated before shipping): AUC 0.971, top-decile lift 9.5x. Closures announce themselves: collapsing occupancy dominates, and fewer recent surveys is a winding-down signature. inputs.features holds raw feature values, inputs.contributions each feature's standardized pull on the log-odds. Predictions never enter the composite. See /v1/models. | p_chow_12m: probability of a change of ownership within 12 months. Deterministic logistic over as-of-date public records, SNF only. Holdout (2025-04 panel, evaluated before shipping): AUC 0.874, top-decile lift 5.0x. inputs.features holds raw feature values, inputs.contributions each feature's standardized pull on the log-odds. Predictions never enter the composite. See /v1/models for full notes.
Distress radar — 12-month termination probability
full board →p(termination, 12m)
0.6%
model v0.1 · computed 2026-07-29
Percentile among SNFs
76.7
100 = most likely to lose certification
Holdout AUC
0.971
top decile caught 95% of actual exits
| Driver | Value | Pull on odds | |
|---|---|---|---|
| For-profit ownership | 0.00 | +1.62 | |
| Deficiencies, last 12 months | 1.00 | +1.24 | |
| Occupancy | 0.97 | -0.95 | |
| Total nurse staffing (HPRD) | 1.25 | +0.82 | |
| Chain size (log) | 3.37 | -0.76 | |
| No PBJ staffing report | 0.00 | +0.39 | |
| Facility size (log beds) | 5.27 | -0.19 | |
| Fine amount, 12m (log) | 0.00 | +0.18 |
Probability the facility's Medicare participation ends within 12 months, from public records only. Red bars raise exit odds. A negative pull from deficiencies is the winding-down signature — surveys stop as a facility empties — not evidence that clean inspections are dangerous.
Staffing vs peers
16| 2025Q4 HPRD | This facility | SD median | National median | National p25–p75 |
|---|---|---|---|---|
| Total nurse | 1.25 | 2.96 | 3.28 | 2.90–3.77 |
| RN | 0.68 | 0.52 | 0.39 | 0.25–0.58 |
| Weekend total | 1.17 | 2.75 | 3.11 | — |
| Weekday total | 1.29 | 3.06 | 3.35 | — |
| Quarter | Days | Avg census | Total HPRD | RN | LPN | CNA | Weekend | Contract % |
|---|---|---|---|---|---|---|---|---|
| 2025Q4 | 92 | 188.9 | 1.25 | 0.68 | 0.17 | 0.40 | 1.17 | 1.1% |
| 2025Q3 | 92 | 187.2 | 1.31 | 0.68 | 0.21 | 0.43 | 1.23 | 3.1% |
| 2025Q2 | 91 | 181.7 | 1.35 | 0.67 | 0.21 | 0.47 | 1.26 | 3.0% |
| 2025Q1 | 90 | 182.0 | 1.20 | 0.63 | 0.20 | 0.36 | 1.16 | 2.5% |
| 2024Q4 | 92 | 183.3 | 1.18 | 0.69 | 0.20 | 0.28 | 1.17 | 5.0% |
| 2024Q3 | 92 | 180.0 | 1.23 | 0.64 | 0.22 | 0.37 | 1.20 | 3.2% |
| 2024Q2 | 91 | 178.5 | 1.25 | 0.60 | 0.23 | 0.41 | 1.26 | 5.7% |
| 2024Q1 | 91 | 178.0 | 1.25 | 0.62 | 0.20 | 0.42 | 1.26 | 5.4% |
| 2023Q4 | 92 | 177.5 | 1.18 | 0.63 | 0.17 | 0.37 | 1.13 | 2.6% |
| 2023Q3 | 92 | 176.8 | 1.21 | 0.60 | 0.23 | 0.38 | 1.12 | 1.9% |
| 2023Q2 | 91 | 175.8 | 1.16 | 0.56 | 0.20 | 0.40 | 1.05 | 2.3% |
| 2023Q1 | 90 | 171.6 | 1.03 | 0.53 | 0.17 | 0.32 | 1.03 | 0.0% |
| 2022Q4 | 92 | 170.1 | 0.99 | 0.52 | 0.15 | 0.33 | 0.95 | 0.1% |
| 2022Q3 | 92 | 171.9 | 1.02 | 0.52 | 0.17 | 0.33 | 1.01 | 0.0% |
| 2022Q2 | 91 | 164.9 | 1.14 | 0.56 | 0.17 | 0.41 | 1.07 | 4.6% |
| 2022Q1 | 90 | 169.8 | 1.11 | 0.59 | 0.21 | 0.31 | 1.07 | 2.9% |
HPRD is census-weighted: total hours over the quarter divided by total resident-days, not an average of daily ratios. Source is CMS Payroll-Based Journal daily records; only SNFs report PBJ, so other settings legitimately return zero rows.
Penalties
0No penalties on record for this facility. Absence of a record here means the sources CII ingests contain none, not that none exists anywhere.
Deficiencies
7D × 3E × 3G × 1
deficiencies by survey year
| Survey | Type | Tag | Deficiency | Scope | Corrected |
|---|---|---|---|---|---|
| 2026-02-05 | Health · complaint | F0689 | Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. | G | 2026-03-05 |
| 2025-01-08 | Health | F0554 | Allow residents to self-administer drugs if determined clinically appropriate. | D | 2025-02-15 |
| 2025-01-08 | Health | F0926 | Have policies on smoking. | E | 2025-02-15 |
| 2024-01-24 | Health · complaint | F0676 | Ensure residents do not lose the ability to perform activities of daily living unless there is a medical reason. | E | 2024-02-15 |
| 2023-09-14 | Health | F0625 | Notify the resident or the resident’s representative in writing how long the nursing home will hold the resident’s bed in cases of transfer to a hospital or therapeutic leave. | D | 2023-10-13 |
| 2023-09-14 | Health | F0658 | Ensure services provided by the nursing facility meet professional standards of quality. | D | 2023-10-13 |
| 2022-08-11 | Health | F0812 | Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. | E | 2022-09-07 |
scope_severity uses the CMS letter grid: A is least serious, L most. J, K and L are immediate jeopardy. Rows are the surveyor's findings of record, not the model's opinion.
Licensure actions
0No licensure actions on record for this facility. Absence of a record here means the sources CII ingests contain none, not that none exists anywhere.
Ownership
40| Owner | Role | Pct | From | Status | Source |
|---|---|---|---|---|---|
| AVERA HEALTH | 5% OR GREATER DIRECT OWNERSHIP INTEREST | — | 2001-01-01 | current | pecos_ownership |
| DEMUTH, JONATHON | CORPORATE DIRECTOR | — | 2025-07-01 | current | pecos_ownership |
| DOVER, JAMES | OPERATIONAL/MANAGERIAL CONTROL | — | 2023-10-23 | current | pecos_ownership |
| ERICKSON, ANTHONY | ADP OF THE SNF | — | 2026-02-16 | current | pecos_ownership |
| ERICKSON, ANTHONY | OPERATIONAL/MANAGERIAL CONTROL | — | 2000-03-30 | current | pecos_ownership |
| HANSON, VICTORIA | CORPORATE OFFICER | — | 2025-05-03 | current | pecos_ownership |
| HOLSTEIN, MARTHA | OPERATIONAL/MANAGERIAL CONTROL | — | 2025-02-01 | current | pecos_ownership |
| HOLSTEIN, MARTHA | ADP OF THE SNF | — | 2026-02-16 | current | pecos_ownership |
| HUNHOFF, BERNIE | CORPORATE DIRECTOR | — | 2019-07-01 | current | pecos_ownership |
| HURLEY, JOHN | CORPORATE DIRECTOR | — | 2020-07-01 | current | pecos_ownership |
| KOLECKA, DEBRA | CORPORATE DIRECTOR | — | 2017-07-01 | current | pecos_ownership |
| LAUTT, JULIE | CORPORATE OFFICER | — | 2020-03-01 | current | pecos_ownership |
| LEON, AMY | CORPORATE DIRECTOR | — | 2019-07-01 | current | pecos_ownership |
| MINER, AMY | CORPORATE DIRECTOR | — | 2025-07-01 | current | pecos_ownership |
| MOELLER, ARTHUR | CORPORATE DIRECTOR | — | 2024-07-01 | current | pecos_ownership |
| REZAC, BARBARA | CORPORATE DIRECTOR | — | 2025-07-01 | current | pecos_ownership |
| SCHINDLER, STEVE | CORPORATE DIRECTOR | — | 2024-07-01 | current | pecos_ownership |
| SCHMEICHEL, STEVE | CORPORATE DIRECTOR | — | 2024-07-01 | current | pecos_ownership |
| STEWARD, BRIAN | CORPORATE DIRECTOR | — | 2018-07-01 | current | pecos_ownership |
| STROM, RICHARD | CORPORATE DIRECTOR | — | 2017-07-01 | current | pecos_ownership |
| WELBIG, LUCILLE | CORPORATE DIRECTOR | — | 2002-07-01 | current | pecos_ownership |
| AMY LEON | CORPORATE DIRECTOR | — | 2019-07-01 | ended 2026-05-18 | pecos_ownership |
| AVERA HEALTH | 5% OR GREATER DIRECT OWNERSHIP INTEREST | — | 2011-02-01 | ended 2026-05-18 | pecos_ownership |
| BERNIE HUNHOFF | CORPORATE DIRECTOR | — | 2019-07-01 | ended 2026-05-18 | pecos_ownership |
| BETH MIKKELSEN | CORPORATE DIRECTOR | — | 2019-07-01 | ended 2026-05-18 | pecos_ownership |
| BOBBY SUTTON | CORPORATE DIRECTOR | — | 2018-06-18 | ended 2026-05-18 | pecos_ownership |
| BRIAN STEWARD | CORPORATE DIRECTOR | — | 2018-07-01 | ended 2026-05-18 | pecos_ownership |
| BRUCE REIFENRATH | CORPORATE DIRECTOR | — | 2019-07-01 | ended 2026-05-18 | pecos_ownership |
| CAROLYN BECKER | CORPORATE DIRECTOR | — | 2017-07-01 | ended 2026-05-18 | pecos_ownership |
| DEBRA KOLECKA | CORPORATE DIRECTOR | — | 2017-07-01 | ended 2026-05-18 | pecos_ownership |
| DOUGLAS EKEREN | W-2 MANAGING EMPLOYEE | — | 2014-09-11 | ended 2026-05-18 | pecos_ownership |
| JOHN HURLEY | CORPORATE DIRECTOR | — | 2020-07-01 | ended 2026-05-18 | pecos_ownership |
| JULIE LAUTT | CORPORATE OFFICER | — | 2020-03-01 | ended 2026-05-18 | pecos_ownership |
| KATHY GREENEWAY | CORPORATE DIRECTOR | — | 2017-07-01 | ended 2026-05-18 | pecos_ownership |
| LUCILLE WELBIG | CORPORATE DIRECTOR | — | 2002-07-01 | ended 2026-05-18 | pecos_ownership |
| RICHARD STROM | CORPORATE DIRECTOR | — | 2017-07-01 | ended 2026-05-18 | pecos_ownership |
| ROXANNE SEIFERT | CORPORATE DIRECTOR | — | 2020-07-01 | ended 2026-05-18 | pecos_ownership |
| RYAN LOECKER | CORPORATE DIRECTOR | — | 2013-07-01 | ended 2026-05-18 | pecos_ownership |
| STEVE SCHINDLER | CORPORATE DIRECTOR | — | 2020-07-01 | ended 2026-05-18 | pecos_ownership |
| THOMAS LORANG | CORPORATE DIRECTOR | — | 2019-07-01 | ended 2026-05-18 | pecos_ownership |
PECOS ownership and managing-control associations. Current edges have no end date in the source; historical edges are retained.
Transactions
0No transactions on record for this facility. Absence of a record here means the sources CII ingests contain none, not that none exists anywhere.
Comparable trades — SD snf
12| Close | Facility | Price | $/bed | Cap rate | Beds | Buyer |
|---|---|---|---|---|---|---|
| 2023-08-31 | RIVERVIEW HEALTHCARE CENTER | — | — | — | 63 | RIVERVIEW SNF OPERATIONS, LLC |
| 2023-08-31 | Wheatcrest Hills Healthcare Center | — | — | — | 60 | WHEATCREST HILLS SNF OPERATIONS, LLC |
| 2023-08-31 | PALISADE HEALTHCARE CENTER | — | — | — | 55 | PALISADE SNF OPERATIONS, LLC |
| 2023-08-31 | PRAIRIE VIEW HEALTHCARE CENTER | — | — | — | 42 | PRAIRIE VIEW SNF OPERATIONS, LLC |
| 2023-08-31 | FIRESTEEL HEALTHCARE CENTER | — | — | — | 125 | FIRESTEEL SNF OPERATIONS, LLC |
| 2023-08-31 | Fountain Springs Healthcare | — | — | — | 90 | FOUNTAIN SPRINGS SNF OPERATIONS, LLC |
| 2019-10-02 | AVANTARA NORTON | — | — | — | 110 | NORTON SD SKILLED NURSING FACILITY LLC |
| 2019-10-02 | AVANTARA HURON | — | — | — | 119 | HURON SD SKILLED NURSING FACILITY, LLC |
| 2019-10-01 | DIAMOND CARE CENTER | — | — | — | 36 | BRIDGEWATER NURSING HOME CORPORATION |
| 2019-07-01 | AVANTARA SAINT CLOUD | — | — | — | 78 | SAINT CLOUD SD SKILLED NURSING FACILITY, LLC |
| 2019-07-01 | AVANTARA WATERTOWN | — | — | — | 51 | WATERTOWN SD SKILLED NURSING FACILITY, LLC |
| 2019-07-01 | AVANTARA CLARK CITY | — | — | — | 35 | CLARK CITY SD SKILLED NURSING FACILITY LLC |
Most recent same-state, same-setting trades. Most CHOW-derived trades carry no disclosed consideration, so price, $/bed, and cap rate show only where a sale price was resolved from a deed or filing — blanks are honest, not missing data.
Market rent context
33| Geo | Kind | BR | Amount | As of | Source |
|---|---|---|---|---|---|
| county 46135 | acs median gross | 0 | $1,350 | 2024-12-31 | CENSUS_ACS5 |
| county 46135 | fmr | 0 | $641 | 2025-10-01 | HUD_USER_FMR |
| county 46135 | acs median gross | 1 | $664 | 2024-12-31 | CENSUS_ACS5 |
| county 46135 | fmr | 1 | $811 | 2025-10-01 | HUD_USER_FMR |
| county 46135 | acs median gross | 2 | $846 | 2024-12-31 | CENSUS_ACS5 |
| county 46135 | fmr | 2 | $929 | 2025-10-01 | HUD_USER_FMR |
| county 46135 | acs median gross | 3 | $819 | 2024-12-31 | CENSUS_ACS5 |
| county 46135 | fmr | 3 | $1,292 | 2025-10-01 | HUD_USER_FMR |
| county 46135 | acs median gross | 4 | $834 | 2024-12-31 | CENSUS_ACS5 |
| county 46135 | fmr | 4 | $1,438 | 2025-10-01 | HUD_USER_FMR |
| county 46135 | acs median gross | $781 | 2024-12-31 | CENSUS_ACS5 | |
| county 46135 | acs recent mover gross | $803 | 2024-12-31 | CENSUS_ACS5 | |
| zcta 57078 | acs median gross | 0 | $1,350 | 2024-12-31 | CENSUS_ACS5 |
| zcta 57078 | acs median gross | 1 | $672 | 2024-12-31 | CENSUS_ACS5 |
| zcta 57078 | acs median gross | 2 | $851 | 2024-12-31 | CENSUS_ACS5 |
| zcta 57078 | acs median gross | 3 | $828 | 2024-12-31 | CENSUS_ACS5 |
| zcta 57078 | acs median gross | $788 | 2024-12-31 | CENSUS_ACS5 | |
| zcta 57078 | acs recent mover gross | $811 | 2024-12-31 | CENSUS_ACS5 | |
| zip 57078 | payment standard 110 | 0 | $704 | 2025-10-01 | HUD_USER_SAFMR |
| zip 57078 | payment standard 90 | 0 | $576 | 2025-10-01 | HUD_USER_SAFMR |
| zip 57078 | safmr | 0 | $640 | 2025-10-01 | HUD_USER_SAFMR |
| zip 57078 | payment standard 110 | 1 | $891 | 2025-10-01 | HUD_USER_SAFMR |
| zip 57078 | payment standard 90 | 1 | $729 | 2025-10-01 | HUD_USER_SAFMR |
| zip 57078 | safmr | 1 | $810 | 2025-10-01 | HUD_USER_SAFMR |
| zip 57078 | payment standard 110 | 2 | $1,023 | 2025-10-01 | HUD_USER_SAFMR |
| zip 57078 | payment standard 90 | 2 | $837 | 2025-10-01 | HUD_USER_SAFMR |
| zip 57078 | safmr | 2 | $930 | 2025-10-01 | HUD_USER_SAFMR |
| zip 57078 | payment standard 110 | 3 | $1,419 | 2025-10-01 | HUD_USER_SAFMR |
| zip 57078 | payment standard 90 | 3 | $1,161 | 2025-10-01 | HUD_USER_SAFMR |
| zip 57078 | safmr | 3 | $1,290 | 2025-10-01 | HUD_USER_SAFMR |
| zip 57078 | payment standard 110 | 4 | $1,584 | 2025-10-01 | HUD_USER_SAFMR |
| zip 57078 | payment standard 90 | 4 | $1,296 | 2025-10-01 | HUD_USER_SAFMR |
| zip 57078 | safmr | 4 | $1,440 | 2025-10-01 | HUD_USER_SAFMR |
ACS median gross rents and HUD FMR/SAFMR for the facility's county and ZIP. Context for underwriting, not facility pricing.