COTEAU DES PRAIRIES HOSPITAL: Form 990, tax year 2017

View the entire original 990 at ProPublica ↗

Organization
COTEAU DES PRAIRIES HOSPITAL (EIN 46-0278210)
Tax period
2017-01-01 to 2017-12-31
Filed
2018-11-15
IRS object ID
201823199349315837
Schema version
2017v2.3
Source
Download XML · Original 990 at ProPublica

Every field in the e-filed return. Faint text is the IRS element name, for citing.

Return header ReturnHeader

FieldValueIRS element (for citing)
Return2018-11-15T15:21:51-06:00ReturnTs
Tax Period End2017-12-31TaxPeriodEndDt

Preparer Firm PreparerFirmGrp

FieldValueIRS element (for citing)
Preparer Firm EIN470585450PreparerFirmEIN

Preparer Firm Name PreparerFirmName

FieldValueIRS element (for citing)
Business Name Line1DOHMAN AKERLUND & EDDY LLCBusinessNameLine1Txt

Preparer US Address PreparerUSAddress

FieldValueIRS element (for citing)
Address Line1PO BOX 470AddressLine1Txt
CityAURORACityNm
State AbbreviationNEStateAbbreviationCd
ZIP688180470ZIPCd
FieldValueIRS element (for citing)
Return Type990ReturnTypeCd
Tax Period Begin2017-01-01TaxPeriodBeginDt

Filer Filer

FieldValueIRS element (for citing)
EIN460278210EIN

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1COTEAU DES PRAIRIES HOSPITALBusinessNameLine1Txt
FieldValueIRS element (for citing)
Business Name ControlCOTEBusinessNameControlTxt
Phone6056987647PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line1205 ORCHARD DRIVEAddressLine1Txt
CitySISSETONCityNm
State AbbreviationSDStateAbbreviationCd
ZIP572622398ZIPCd

Business Officer BusinessOfficerGrp

FieldValueIRS element (for citing)
PersonGREG WEAVERPersonNm
Person TitleINTERIM CEO/COOPersonTitleTxt
Phone6056984601PhoneNum
Signature2018-11-15SignatureDt
Discuss With Paid PreparerYes (true)DiscussWithPaidPreparerInd

Preparer Person PreparerPersonGrp

FieldValueIRS element (for citing)
Preparer PersonTIMOTHY J COUFALPreparerPersonNm
PTINP00964304PTIN
Phone4026946404PhoneNum
Preparation2018-11-15PreparationDt

Filing Security Information FilingSecurityInformation

IP Address IPAddress

FieldValueIRS element (for citing)
I Pv4 Address199.36.118.40IPv4AddressTxt
FieldValueIRS element (for citing)
IP2018-11-15IPDt
IP Tm15:21:51IPTm
IP TimezoneCSIPTimezoneCd
Filing License TypePFilingLicenseTypeCd
At Submission Creation Device IdE144B8C64C33D7B8D14B928B392543FF2AF635ABAtSubmissionCreationDeviceId
At Submission Filing Device IdE144B8C64C33D7B8D14B928B392543FF2AF635ABAtSubmissionFilingDeviceId
FieldValueIRS element (for citing)
Tax2017TaxYr
Build TS2018-06-14 16:35:46ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Principal OfficerGREG WEAVERPrincipalOfficerNm

US Address USAddress

FieldValueIRS element (for citing)
Address Line1SAME AS C ABOVEAddressLine1Txt
CitySISSETONCityNm
State AbbreviationSDStateAbbreviationCd
ZIP572622398ZIPCd
FieldValueIRS element (for citing)
Gross Receipts$18,020,529GrossReceiptsAmt
Group Return For AffiliatesfalseGroupReturnForAffiliatesInd
Organization501c3Yes (X)Organization501c3Ind
Website AddressCDPHEALTH.COMWebsiteAddressTxt
Type Of Organization CorpYes (X)TypeOfOrganizationCorpInd
Formation1967FormationYr
Legal Domicile StateSDLegalDomicileStateCd
Activity Or MissionPROVIDE HEALTHCARE SERVICES TO THE POPULATION OF SISSETON, SD, AND THE SURROUNDING AREAS.ActivityOrMissionDesc
Voting Members Governing Body8VotingMembersGoverningBodyCnt
Voting Members Independent8VotingMembersIndependentCnt
Total Employee170TotalEmployeeCnt
Total Volunteers10TotalVolunteersCnt
Total Gross UBI$0TotalGrossUBIAmt
PY Contributions Grants$227,757PYContributionsGrantsAmt
CY Contributions Grants$113,624CYContributionsGrantsAmt
PY Program Service Revenue$17,120,006PYProgramServiceRevenueAmt
CY Program Service Revenue$17,879,014CYProgramServiceRevenueAmt
PY Investment Income$670PYInvestmentIncomeAmt
CY Investment Income$9,891CYInvestmentIncomeAmt
PY Other Revenue$14,923PYOtherRevenueAmt
CY Other Revenue$18,000CYOtherRevenueAmt
PY Total Revenue$17,363,356PYTotalRevenueAmt
CY Total Revenue$18,020,529CYTotalRevenueAmt
PY Grants And Similar Paid$1,260PYGrantsAndSimilarPaidAmt
CY Grants And Similar Paid$0CYGrantsAndSimilarPaidAmt
CY Benefits Paid To Members$0CYBenefitsPaidToMembersAmt
PY Salaries Comp Emp Bnft Paid$9,923,263PYSalariesCompEmpBnftPaidAmt
CY Salaries Comp Emp Bnft Paid$10,173,070CYSalariesCompEmpBnftPaidAmt
CY Total Prof Fndrsng Expns$0CYTotalProfFndrsngExpnsAmt
CY Total Fundraising Expense$0CYTotalFundraisingExpenseAmt
PY Other Expenses$8,153,194PYOtherExpensesAmt
CY Other Expenses$8,089,435CYOtherExpensesAmt
PY Total Expenses$18,077,717PYTotalExpensesAmt
CY Total Expenses$18,262,505CYTotalExpensesAmt
PY Revenues Less Expenses-$714,361PYRevenuesLessExpensesAmt
CY Revenues Less Expenses-$241,976CYRevenuesLessExpensesAmt
Total Assets BOY$14,617,772TotalAssetsBOYAmt
Total Assets EOY$14,203,516TotalAssetsEOYAmt
Total Liabilities BOY$8,364,004TotalLiabilitiesBOYAmt
Total Liabilities EOY$8,214,454TotalLiabilitiesEOYAmt
Net Assets Or Fund Balances BOY$6,253,768NetAssetsOrFundBalancesBOYAmt
Net Assets Or Fund Balances EOY$5,989,062NetAssetsOrFundBalancesEOYAmt
Info In Schedule O Part IIIYes (X)InfoInScheduleOPartIIIInd
MissionQUALITY CARE WITH A PERSONAL TOUCH, CLOSE TO HOME.MissionDesc
Significant New Program SrvcfalseSignificantNewProgramSrvcInd
Significant ChangefalseSignificantChangeInd
Expense$14,785,211ExpenseAmt
Revenue$17,698,114RevenueAmt
DescCOTEAU DES PRAIRIES HOSPITAL (CDPH) IS A 25 BED ACUTE CARE HOSPITAL AND PHYSICIAN CLINICS LOCATED IN SISSETON, SOUTH DAKOTA AND THE SURROUNDING AREA. THE HOSPITAL PROVIDES HEALTH CARE SERVICES TO PATIENTS WHO MEET CERTAIN CRITERIA UNDER ITS CHARITY CARE POLICY WITHOUT CHARGE OR AT AMOUNTS LESS THEN ESTABLISHED RATES. SINCE THE HOSPITAL DOES NOT PURSUE COLLECTION OF THESE AMOUNTS, THEY ARE NOT REPORTED AS PATIENT SERVICE REVENUE. THE ESTIMATED COST OF PROVIDING THESE SERVICES WAS 4,754 FOR THE YEAR ENDED DECEMBER 31, 2017. STATISTICS FOR THE PERIOD ENDED DECEMBER 31, 2017, ARE AS FOLLOWS: ACUTE PATIENT DAYS = 1,165, SWING-BED PATIENT DAYS = 464, NEWBORN NURSERY DAYS = 232, EMERGENCY ROOM VISITS = 4,248, CLINIC VISITS = 18,499, AND NUMEROUS OTHER OUTPATIENT VISITS.Desc
Total Program Service Expenses$14,785,211TotalProgramServiceExpensesAmt
Described In Section501c3Yes (true)DescribedInSection501c3Ind
Schedule B RequiredYes (true)ScheduleBRequiredInd
Political Campaign ActyfalsePoliticalCampaignActyInd
Lobbying ActivitiesfalseLobbyingActivitiesInd
Subject To Proxy TaxfalseSubjectToProxyTaxInd
Donor Advised FundfalseDonorAdvisedFundInd
Conservation EasementsfalseConservationEasementsInd
Collections Of ArtfalseCollectionsOfArtInd
Credit CounselingfalseCreditCounselingInd
Temp Or Permanent EndowmentsYes (true)TempOrPermanentEndowmentsInd
Report Land Building EquipmentYes (true)ReportLandBuildingEquipmentInd
Report Investments Other SecfalseReportInvestmentsOtherSecInd
Report Program Related InvstfalseReportProgramRelatedInvstInd
Report Other AssetsfalseReportOtherAssetsInd
Report Other LiabilitiesfalseReportOtherLiabilitiesInd
Include FIN48 FootnoteYes (true)IncludeFIN48FootnoteInd
Independent Audit Fincl StmtfalseIndependentAuditFinclStmtInd
Consolidated Audit Fincl StmtYes (true)ConsolidatedAuditFinclStmtInd
School OperatingfalseSchoolOperatingInd
Foreign OfficefalseForeignOfficeInd
Foreign ActivitiesfalseForeignActivitiesInd
More Than5000 K To OrgfalseMoreThan5000KToOrgInd
More Than5000 K To IndividualsfalseMoreThan5000KToIndividualsInd
Professional FundraisingfalseProfessionalFundraisingInd
Fundraising ActivitiesfalseFundraisingActivitiesInd
Gaming ActivitiesfalseGamingActivitiesInd
Operate HospitalYes (true)OperateHospitalInd
Audited Financial Stmt AttYes (true)AuditedFinancialStmtAttInd
Grants To OrganizationsfalseGrantsToOrganizationsInd
Grants To IndividualsfalseGrantsToIndividualsInd
Schedule J RequiredYes (true)ScheduleJRequiredInd
Tax Exempt BondsYes (true)TaxExemptBondsInd
Invest Tax Exempt BondsfalseInvestTaxExemptBondsInd
Escrow AccountfalseEscrowAccountInd
On Behalf Of IssuerfalseOnBehalfOfIssuerInd
Engaged In Excess Benefit TransfalseEngagedInExcessBenefitTransInd
PY Excess Benefit TransfalsePYExcessBenefitTransInd
Loan OutstandingfalseLoanOutstandingInd
Grant To Related PersonfalseGrantToRelatedPersonInd
Business Rln With Org MemfalseBusinessRlnWithOrgMemInd
Business Rln With Fam MemfalseBusinessRlnWithFamMemInd
Business Rln With Officer EntfalseBusinessRlnWithOfficerEntInd
Deductible Non Cash ContrifalseDeductibleNonCashContriInd
Deductible Art ContributionfalseDeductibleArtContributionInd
Terminate OperationsfalseTerminateOperationsInd
Partial LiquidationfalsePartialLiquidationInd
Disregarded EntityfalseDisregardedEntityInd
Related EntityYes (true)RelatedEntityInd
Related Organization Ctrl EntfalseRelatedOrganizationCtrlEntInd
Trnsfr Exmpt Non Chrtbl Rltd OrgfalseTrnsfrExmptNonChrtblRltdOrgInd
Activities Conducted PrtshpfalseActivitiesConductedPrtshpInd
Schedule O RequiredYes (true)ScheduleORequiredInd
IRP Document22IRPDocumentCnt
IRP Document W2 G0IRPDocumentW2GCnt
Backup Wthld ComplianceYes (true)BackupWthldComplianceInd
Employee170EmployeeCnt
Employment Tax Returns FiledYes (true)EmploymentTaxReturnsFiledInd
Unrelated Bus Incm Over LimitfalseUnrelatedBusIncmOverLimitInd
Foreign Financial AccountfalseForeignFinancialAccountInd
Prohibited Tax Shelter TransfalseProhibitedTaxShelterTransInd
Taxable Party NotificationfalseTaxablePartyNotificationInd
Nondeductible ContributionsfalseNondeductibleContributionsInd
Quid Pro Quo ContributionsfalseQuidProQuoContributionsInd
Form8282 Property Disposed OffalseForm8282PropertyDisposedOfInd
Rcv Fnds To Pay Prsnl Bnft CntrctfalseRcvFndsToPayPrsnlBnftCntrctInd
Pay Premiums Prsnl Bnft CntrctfalsePayPremiumsPrsnlBnftCntrctInd
Indoor Tanning ServicesfalseIndoorTanningServicesInd
Info In Schedule O Part VIYes (X)InfoInScheduleOPartVIInd
Governing Body Voting Members8GoverningBodyVotingMembersCnt
Independent Voting Member8IndependentVotingMemberCnt
Family Or Business RlnfalseFamilyOrBusinessRlnInd
Delegation Of Mgmt DutiesfalseDelegationOfMgmtDutiesInd
Change To Org DocumentsfalseChangeToOrgDocumentsInd
Material Diversion Or MisusefalseMaterialDiversionOrMisuseInd
Members Or StockholdersfalseMembersOrStockholdersInd
Election Of Board MembersfalseElectionOfBoardMembersInd
Decisions Subject To ApprovafalseDecisionsSubjectToApprovaInd
Minutes Of Governing BodyYes (true)MinutesOfGoverningBodyInd
Minutes Of CommitteesYes (true)MinutesOfCommitteesInd
Officer Mailing AddressfalseOfficerMailingAddressInd
Local ChaptersfalseLocalChaptersInd
Form990 Provided To Gvrn BodyYes (true)Form990ProvidedToGvrnBodyInd
Conflict Of Interest PolicyYes (true)ConflictOfInterestPolicyInd
Annual Disclosure Covered PrsnYes (true)AnnualDisclosureCoveredPrsnInd
Regular Monitoring EnfrcYes (true)RegularMonitoringEnfrcInd
Whistleblower PolicyfalseWhistleblowerPolicyInd
Document Retention PolicyYes (true)DocumentRetentionPolicyInd
Compensation Process CEOYes (true)CompensationProcessCEOInd
Compensation Process OtherYes (true)CompensationProcessOtherInd
Investment In Joint VenturefalseInvestmentInJointVentureInd
Upon RequestYes (X)UponRequestInd

Books In Care Of Detail BooksInCareOfDetail

FieldValueIRS element (for citing)
PersonMYLA PETERSON CONTROLLERPersonNm
Phone6056984605PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line1205 ORCHARD DRIVEAddressLine1Txt
CitySISSETONCityNm
State AbbreviationSDStateAbbreviationCd
ZIP572622398ZIPCd

Form990 Part VII Section A Form990PartVIISectionAGrp (15 entries)

TitleTitleTxtAverage Hours Per WeekAverageHoursPerWeekRtIndividual Trustee Or DirectorIndividualTrusteeOrDirectorIndOfficerOfficerIndReportable Comp From OrgReportableCompFromOrgAmtReportable Comp From Rltd OrgReportableCompFromRltdOrgAmtOther CompensationOtherCompensationAmtAverage Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRtHighest Compensated EmployeeHighestCompensatedEmployeeInd
TERRY JASPERS
PRESIDENT2.00Yes (X)Yes (X)$0$0$0
FAYE JOHNSTON
VICE PRESIDE2.00Yes (X)Yes (X)$0$0$0
MATT GLYNN
SECRETARY2.00Yes (X)Yes (X)$0$0$0
YVONNE HIPPEN
TREASURER2.00Yes (X)Yes (X)$0$0$0
ERIN CAMERON
MEMBER1.00Yes (X)$0$0$0
DAVE GLEASON
MEMBER1.00Yes (X)$0$0$00.25
STEVEN MCCLEEREY
MEMBER1.00Yes (X)$0$0$00.25
GERALDINE OPSAL
MEMBER1.00Yes (X)$0$0$00.25
MICHAEL COYLE
CEO40.00Yes (X)$170,014$0$37,7720.25
GREG WEAVER
INTERIM CEO/40.00Yes (X)$98,106$0$0
SHERRYL TOMBOULIAN MD
FAMILY PRACT40.00$413,337$0$32,665Yes (X)
STANLEY GALLAGER DO
OSTEOPATHY40.00$384,000$0$26,216Yes (X)
RAMON MORALES MD
GENERAL SURG40.00$356,312$0$32,644Yes (X)
JUDY BEUMER MD
EMERGENCY ME40.00$352,792$0$26,129Yes (X)
DAVID MEADOWS MD
FAMILY PRACT40.00$300,535$0$11,903Yes (X)
FieldValueIRS element (for citing)
Total Reportable Comp From Org$2,075,096TotalReportableCompFromOrgAmt
Total Other Compensation$167,329TotalOtherCompensationAmt
Indiv Rcvd Greater Than100 K13IndivRcvdGreaterThan100KCnt
Former Ofcr Employees ListedfalseFormerOfcrEmployeesListedInd
Total Comp Greater Than150 KYes (true)TotalCompGreaterThan150KInd
Compensation From Other SrcsfalseCompensationFromOtherSrcsInd

Contractor Compensation ContractorCompensationGrp

Contractor Name ContractorName

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1FISHER ANESTHESIA PLCBusinessNameLine1Txt

Contractor Address ContractorAddress

US Address USAddress

FieldValueIRS element (for citing)
Address Line11004 5TH AVENUE NORTHAddressLine1Txt
CityWHEATONCityNm
State AbbreviationMNStateAbbreviationCd
ZIP56296ZIPCd
FieldValueIRS element (for citing)
ServicesANESTHESIA SVSCServicesDesc
Compensation$300,000CompensationAmt
FieldValueIRS element (for citing)
Cntrct Rcvd Greater Than100 K1CntrctRcvdGreaterThan100KCnt
All Other Contributions$113,624AllOtherContributionsAmt
Total Contributions$113,624TotalContributionsAmt

Program Service Revenue ProgramServiceRevenueGrp (4 entries)

DescDescBusinessBusinessCdTotal Revenue ColumnTotalRevenueColumnAmtRelated Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt
NET PATIENT SERVICE REVENUE622110$16,953,482$16,953,482
340B PHARMACY REVENUE446110$560,150$560,150
EHR INCENTIVE REVENUE900099$198,900$198,900
OTHER REVENUE900099$166,482$166,482
FieldValueIRS element (for citing)
Total Program Service Revenue$17,879,014TotalProgramServiceRevenueAmt

Investment Income InvestmentIncomeGrp

FieldValueIRS element (for citing)
Total Revenue Column$9,891TotalRevenueColumnAmt
Exclusion$9,891ExclusionAmt

Gross Rents GrossRentsGrp

FieldValueIRS element (for citing)
Real$18,000RealAmt

Rental Income Or Loss RentalIncomeOrLossGrp

FieldValueIRS element (for citing)
Real$18,000RealAmt

Net Rental Income Or Loss NetRentalIncomeOrLossGrp

FieldValueIRS element (for citing)
Total Revenue Column$18,000TotalRevenueColumnAmt
Exclusion$18,000ExclusionAmt

Total Revenue TotalRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$18,020,529TotalRevenueColumnAmt
Related Or Exempt Func Income$17,879,014RelatedOrExemptFuncIncomeAmt
Exclusion$27,891ExclusionAmt
FieldValueIRS element (for citing)
Info In Schedule O Part IXYes (X)InfoInScheduleOPartIXInd

Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp

FieldValueIRS element (for citing)
Total$249,695TotalAmt
Management And General$249,695ManagementAndGeneralAmt

Other Salaries And Wages OtherSalariesAndWagesGrp

FieldValueIRS element (for citing)
Total$7,922,105TotalAmt
Program Services$7,101,523ProgramServicesAmt
Management And General$820,582ManagementAndGeneralAmt

Pension Plan Contributions PensionPlanContributionsGrp

FieldValueIRS element (for citing)
Total$261,271TotalAmt
Program Services$213,761ProgramServicesAmt
Management And General$47,510ManagementAndGeneralAmt

Other Employee Benefits OtherEmployeeBenefitsGrp

FieldValueIRS element (for citing)
Total$1,739,999TotalAmt
Program Services$1,360,387ProgramServicesAmt
Management And General$379,612ManagementAndGeneralAmt

Fees For Services Legal FeesForServicesLegalGrp

FieldValueIRS element (for citing)
Total$50,909TotalAmt
Management And General$50,909ManagementAndGeneralAmt

Fees For Services Accounting FeesForServicesAccountingGrp

FieldValueIRS element (for citing)
Total$125,972TotalAmt
Management And General$125,972ManagementAndGeneralAmt

Fees For Services Other FeesForServicesOtherGrp

FieldValueIRS element (for citing)
Total$2,864,430TotalAmt
Program Services$2,152,780ProgramServicesAmt
Management And General$711,650ManagementAndGeneralAmt

Advertising AdvertisingGrp

FieldValueIRS element (for citing)
Total$70,243TotalAmt
Management And General$70,243ManagementAndGeneralAmt

Office Expenses OfficeExpensesGrp

FieldValueIRS element (for citing)
Total$674,585TotalAmt
Program Services$557,240ProgramServicesAmt
Management And General$117,345ManagementAndGeneralAmt

Information Technology InformationTechnologyGrp

FieldValueIRS element (for citing)
Total$669,524TotalAmt
Management And General$669,524ManagementAndGeneralAmt

Occupancy OccupancyGrp

FieldValueIRS element (for citing)
Total$176,074TotalAmt
Program Services$176,074ProgramServicesAmt

Travel TravelGrp

FieldValueIRS element (for citing)
Total$87,644TotalAmt
Program Services$51,364ProgramServicesAmt
Management And General$36,280ManagementAndGeneralAmt

Conferences Meetings ConferencesMeetingsGrp

FieldValueIRS element (for citing)
Total$22,819TotalAmt
Program Services$22,819ProgramServicesAmt

Interest InterestGrp

FieldValueIRS element (for citing)
Total$306,677TotalAmt
Program Services$306,677ProgramServicesAmt

Depreciation Depletion DepreciationDepletionGrp

FieldValueIRS element (for citing)
Total$881,086TotalAmt
Program Services$881,086ProgramServicesAmt

Insurance InsuranceGrp

FieldValueIRS element (for citing)
Total$176,475TotalAmt
Program Services$66,151ProgramServicesAmt
Management And General$110,324ManagementAndGeneralAmt

Other Expenses OtherExpensesGrp (4 entries)

DescDescTotalTotalAmtProgram ServicesProgramServicesAmtManagement And GeneralManagementAndGeneralAmt
MEDICAL SUPPLIES$1,749,055$1,706,136$42,919
LICENSES AND PERMITS$175,144$131,636$43,508
FOOD$57,577$57,577
FOUNDATION$1,221$1,221

Total Functional Expenses TotalFunctionalExpensesGrp

FieldValueIRS element (for citing)
Total$18,262,505TotalAmt
Program Services$14,785,211ProgramServicesAmt
Management And General$3,477,294ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Savings And Temp Cash Invst SavingsAndTempCashInvstGrp

FieldValueIRS element (for citing)
BOY$480,356BOYAmt
EOY$469,080EOYAmt

Accounts Receivable AccountsReceivableGrp

FieldValueIRS element (for citing)
BOY$3,423,825BOYAmt
EOY$4,215,785EOYAmt

Inventories For Sale Or Use InventoriesForSaleOrUseGrp

FieldValueIRS element (for citing)
BOY$266,434BOYAmt
EOY$364,134EOYAmt

Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp

FieldValueIRS element (for citing)
BOY$85,344BOYAmt
EOY$63,587EOYAmt
FieldValueIRS element (for citing)
Land Bldg Equip Cost Or Other Bss$17,813,208LandBldgEquipCostOrOtherBssAmt
Land Bldg Equip Accum Deprec$9,131,390LandBldgEquipAccumDeprecAmt

Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp

FieldValueIRS element (for citing)
BOY$9,543,112BOYAmt
EOY$8,681,818EOYAmt

Intangible Assets IntangibleAssetsGrp

FieldValueIRS element (for citing)
BOY$65,901BOYAmt
EOY$60,212EOYAmt

Other Assets Total OtherAssetsTotalGrp

FieldValueIRS element (for citing)
BOY$752,800BOYAmt
EOY$348,900EOYAmt

Total Assets TotalAssetsGrp

FieldValueIRS element (for citing)
BOY$14,617,772BOYAmt
EOY$14,203,516EOYAmt

Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp

FieldValueIRS element (for citing)
BOY$1,416,369BOYAmt
EOY$1,485,780EOYAmt

Deferred Revenue DeferredRevenueGrp

FieldValueIRS element (for citing)
BOY$105,492BOYAmt
EOY$82,738EOYAmt

Tax Exempt Bond Liabilities TaxExemptBondLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$6,842,143BOYAmt
EOY$6,645,936EOYAmt

Total Liabilities TotalLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$8,364,004BOYAmt
EOY$8,214,454EOYAmt
FieldValueIRS element (for citing)
Organization Follows SFAS117Yes (X)OrganizationFollowsSFAS117Ind

Unrestricted Net Assets UnrestrictedNetAssetsGrp

FieldValueIRS element (for citing)
BOY$6,231,038BOYAmt
EOY$5,989,062EOYAmt

Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp

FieldValueIRS element (for citing)
BOY$22,730BOYAmt

Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$6,253,768BOYAmt
EOY$5,989,062EOYAmt

Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$14,617,772BOYAmt
EOY$14,203,516EOYAmt
FieldValueIRS element (for citing)
Reconcilation Revenue Expnss-$241,976ReconcilationRevenueExpnssAmt
Other Changes In Net Assets-$22,730OtherChangesInNetAssetsAmt
Method Of Accounting AccrualYes (X)MethodOfAccountingAccrualInd
Accountant Compile Or ReviewfalseAccountantCompileOrReviewInd
FS AuditedYes (true)FSAuditedInd

FS Audited Basis FSAuditedBasisGrp

FieldValueIRS element (for citing)
Consolidated Basis Fincl StmtYes (X)ConsolidatedBasisFinclStmtInd
FieldValueIRS element (for citing)
Audit CommitteeYes (true)AuditCommitteeInd
Federal Grant Audit RequiredfalseFederalGrantAuditRequiredInd

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
HospitalYes (X)HospitalInd

Schedule B IRS990ScheduleB

Schedule D IRS990ScheduleD

CY Endwmt Fund CYEndwmtFundGrp

FieldValueIRS element (for citing)
Beginning Year Balance$96,385BeginningYearBalanceAmt
Investment Earnings Or Losses$448InvestmentEarningsOrLossesAmt
Other Expenditures$22,730OtherExpendituresAmt
End Year Balance$74,103EndYearBalanceAmt

CY Minus1 Yr Endwmt Fund CYMinus1YrEndwmtFundGrp

FieldValueIRS element (for citing)
Beginning Year Balance$473,293BeginningYearBalanceAmt
Contributions$22,730ContributionsAmt
Investment Earnings Or Losses$362InvestmentEarningsOrLossesAmt
Other Expenditures$400,000OtherExpendituresAmt
End Year Balance$96,385EndYearBalanceAmt

CY Minus2 Yr Endwmt Fund CYMinus2YrEndwmtFundGrp

FieldValueIRS element (for citing)
Contributions$403,709ContributionsAmt
Investment Earnings Or Losses$4,885InvestmentEarningsOrLossesAmt
Other Expenditures$64,699OtherExpendituresAmt
End Year Balance$473,293EndYearBalanceAmt
FieldValueIRS element (for citing)
Board Designated Balance EOY1.00000BoardDesignatedBalanceEOYPct
Endowments Held Unrelated OrgfalseEndowmentsHeldUnrelatedOrgInd
Endowments Held Related OrgfalseEndowmentsHeldRelatedOrgInd

Land LandGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$13,556OtherCostOrOtherBasisAmt
Book Value$13,556BookValueAmt

Buildings BuildingsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$10,929,714OtherCostOrOtherBasisAmt
Depreciation$4,259,020DepreciationAmt
Book Value$6,670,694BookValueAmt

Equipment EquipmentGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$6,635,916OtherCostOrOtherBasisAmt
Depreciation$4,715,426DepreciationAmt
Book Value$1,920,490BookValueAmt

Other Land Buildings OtherLandBuildingsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$234,022OtherCostOrOtherBasisAmt
Depreciation$156,944DepreciationAmt
Book Value$77,078BookValueAmt
FieldValueIRS element (for citing)
Total Book Value Land Buildings$8,681,818TotalBookValueLandBuildingsAmt
Footnote TextYes (X)FootnoteTextInd

Supplemental Information Detail SupplementalInformationDetail (2 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
SCHEDULE D, PAGE 2, PART V, LINE 4FUNDS ARE BOARD DESIGNATED FOR CAPITAL IMPROVEMENTS AND DEBT REDEMPTION.
SCHEDULE D, PAGE 3, PART XTHE ORGANIZATION IS STRUCTURED AS A SOUTH DAKOTA NONPROFIT CORPORATION AND HAS BEEN RECOGNIZED BY THE INTERNAL REVENUE SERVICE (IRS) AS EXEMPT FROM FEDERAL INCOME TAXES UNDER INTERNAL REVENUE CODE SECTION 501(C)(3). THE ORGANIZATION IS ANNUALLY REQUIRED TO FILE A RETURN OF ORGANIZATION EXEMPT FROM INCOME TAX (FORM 990) WITH THE IRS. IN ADDITION, THE ORGANIZATION IS SUBJECT TO INCOME TAX ON NET INCOME THAT IS DERIVED FROM BUSINESS ACTIVITIES THAT ARE UNRELATED TO ITS EXEMPT PURPOSE. THE ORGANIZATION HAS DETERMINED IT IS NOT SUBJECT TO UNRELATED BUSINESS INCOME TAX AND HAS NOT FILED AN EXEMPT ORGANIZATION BUSINESS INCOME TAX RETURN (FORM 990T) WITH THE IRS. THE ORGANIZATION BELIEVES THAT IT HAS APPROPRIATE SUPPORT FOR ANY TAX POSITIONS TAKEN AFFECTING ITS ANNUAL FILING REQUIREMENTS, AND AS SUCH, DOES NOT HAVE ANY UNCERTAIN TAX POSITIONS THAT ARE MATERIAL TO THE FINANCIAL STATEMENTS. THE ORGANIZATION HAS NO RESERVES FOR UNCERTAIN TAX POSITIONS AT DECEMBER 31, 2017 OR 2016. ADDITIONALLY, THE ORGANIZATION HAS NOT RECOGNIZED ANY INTEREST OR PENALTIES IN RELATION TO TAX FILINGS AS OF OR FOR THE YEARS ENDED DECEMBER 31, 2017 AND 2016.

Schedule H IRS990ScheduleH

FieldValueIRS element (for citing)
Financial Assistance PolicyYes (true)FinancialAssistancePolicyInd
Written PolicyYes (true)WrittenPolicyInd
All Hospitals PolicyYes (X)AllHospitalsPolicyInd
FPG Reference Free CareYes (true)FPGReferenceFreeCareInd
Percent150Yes (X)Percent150Ind
FPG Reference Discounted CareYes (true)FPGReferenceDiscountedCareInd

Discounted Care Oth Percentage DiscountedCareOthPercentageGrp

FieldValueIRS element (for citing)
OtherYes (X)OtherInd
Discounted Care Other1.750000000000DiscountedCareOtherPct
FieldValueIRS element (for citing)
Free Care Medically IndigentYes (true)FreeCareMedicallyIndigentInd
Financial Assistance BudgetYes (true)FinancialAssistanceBudgetInd
Expenses Exceed BudgetfalseExpensesExceedBudgetInd
Annual Community Bnft ReportfalseAnnualCommunityBnftReportInd

Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp

FieldValueIRS element (for citing)
Total Community Benefit Expns$4,535TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns$4,535NetCommunityBenefitExpnsAmt
Total Expense0.00020TotalExpensePct

Unreimbursed Medicaid UnreimbursedMedicaidGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$3,554,362TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$3,018,783DirectOffsettingRevenueAmt
Net Community Benefit Expns$535,579NetCommunityBenefitExpnsAmt
Total Expense0.02930TotalExpensePct

Total Financial Assistance Typ TotalFinancialAssistanceTyp

FieldValueIRS element (for citing)
Total Community Benefit Expns$3,558,897TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$3,018,783DirectOffsettingRevenueAmt
Net Community Benefit Expns$540,114NetCommunityBenefitExpnsAmt
Total Expense0.02960TotalExpensePct

Community Health Services CommunityHealthServicesGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$7,443TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$3,510DirectOffsettingRevenueAmt
Net Community Benefit Expns$3,933NetCommunityBenefitExpnsAmt
Total Expense0.00020TotalExpensePct

Total Other Benefits TotalOtherBenefitsGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$7,443TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$3,510DirectOffsettingRevenueAmt
Net Community Benefit Expns$3,933NetCommunityBenefitExpnsAmt
Total Expense0.00020TotalExpensePct

Total Community Benefits TotalCommunityBenefitsGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$3,566,340TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$3,022,293DirectOffsettingRevenueAmt
Net Community Benefit Expns$544,047NetCommunityBenefitExpnsAmt
Total Expense0.02980TotalExpensePct

Coalition Building CoalitionBuildingGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$2,224TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns$2,224NetCommunityBenefitExpnsAmt
Total Expense0.00010TotalExpensePct

Health Improvement Advocacy HealthImprovementAdvocacyGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$11,202TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$33,907DirectOffsettingRevenueAmt

Workforce Development WorkforceDevelopmentGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$214TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns$214NetCommunityBenefitExpnsAmt

Total Communtity Building Acty TotalCommuntityBuildingActyGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$13,640TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$33,907DirectOffsettingRevenueAmt
Net Community Benefit Expns$2,438NetCommunityBenefitExpnsAmt
Total Expense0.00010TotalExpensePct
FieldValueIRS element (for citing)
Bad Debt Expense ReportedfalseBadDebtExpenseReportedInd
Bad Debt Expense$580,232BadDebtExpenseAmt
Bad Debt Expense Attributable$290,116BadDebtExpenseAttributableAmt
Reimbursed By Medicare$4,788,615ReimbursedByMedicareAmt
Cost Of Care Reimbursed By Medcr$4,856,903CostOfCareReimbursedByMedcrAmt
Medicare Surplus Or Shortfall-$68,288MedicareSurplusOrShortfallAmt

Costing Methodology Used CostingMethodologyUsedGrp

FieldValueIRS element (for citing)
OtherYes (X)OtherInd
FieldValueIRS element (for citing)
Written Debt Collection PolicyYes (true)WrittenDebtCollectionPolicyInd
Financial Assistance PrvsnYes (true)FinancialAssistancePrvsnInd
Hospital Facilities1HospitalFacilitiesCnt

Hospital Facilities HospitalFacilitiesGrp

FieldValueIRS element (for citing)
Facility1FacilityNum

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1COTEAU DES PRAIRIESBusinessNameLine1Txt
Business Name Line2HOSPITAL & CLINICBusinessNameLine2Txt

US Address USAddress

FieldValueIRS element (for citing)
Address Line1205 ORCHARD DRIVEAddressLine1Txt
CitySISSETONCityNm
State AbbreviationSDStateAbbreviationCd
ZIP57262ZIPCd
FieldValueIRS element (for citing)
Website AddressCDPHEALTH.COMWebsiteAddressTxt
State License60020StateLicenseNum
Licensed HospitalYes (X)LicensedHospitalInd
General Medical And SurgicalYes (X)GeneralMedicalAndSurgicalInd
Critical Access HospitalYes (X)CriticalAccessHospitalInd
Emergency Room24 HrsYes (X)EmergencyRoom24HrsInd
Other1 PROVIDER BASED RHCOtherDesc

Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp

Hospital Facility Name HospitalFacilityName

FieldValueIRS element (for citing)
Business Name Line1COTEAU DES PRAIRIESBusinessNameLine1Txt
Business Name Line2HOSPITAL & CLINICBusinessNameLine2Txt
FieldValueIRS element (for citing)
Facility1FacilityNum
First Licensed CY Or PYfalseFirstLicensedCYOrPYInd
Tax Exempt Hospital CY Or PYfalseTaxExemptHospitalCYOrPYInd
CHNA ConductedYes (true)CHNAConductedInd
Community DefinitionYes (X)CommunityDefinitionInd
Community DemographicsYes (X)CommunityDemographicsInd
Existing ResourcesYes (X)ExistingResourcesInd
How Data ObtainedYes (X)HowDataObtainedInd
Community Health NeedsYes (X)CommunityHealthNeedsInd
Other Health IssuesYes (X)OtherHealthIssuesInd
Community Hlth Needs Id ProcessYes (X)CommunityHlthNeedsIdProcessInd
Consulting ProcessYes (X)ConsultingProcessInd
CHNA Conducted15CHNAConductedYr
Take Into Account Others InputYes (true)TakeIntoAccountOthersInputInd
CHNA Conducted With Other FcltsfalseCHNAConductedWithOtherFcltsInd
CHNA Conducted With Non FcltsfalseCHNAConductedWithNonFcltsInd
CHNA Report Widely AvailableYes (true)CHNAReportWidelyAvailableInd
Rpt Available On Own WebsiteYes (X)RptAvailableOnOwnWebsiteInd
Own Website URLCDPHEALTH.COMOwnWebsiteURLTxt
Paper Copy Public InspectionYes (X)PaperCopyPublicInspectionInd
Implementation Strategy AdoptYes (true)ImplementationStrategyAdoptInd
Implementation Strategy Adpt15ImplementationStrategyAdptYr
Strategy Posted WebsiteYes (true)StrategyPostedWebsiteInd
Strategy Website URLCDPHEALTH.COMStrategyWebsiteURLTxt
Strategy AttachedfalseStrategyAttachedInd
Organization Incur Excise TaxfalseOrganizationIncurExciseTaxInd
Elig Criteria ExplainedYes (true)EligCriteriaExplainedInd
FPG Family Incm Lmt Free DscntYes (X)FPGFamilyIncmLmtFreeDscntInd
FPG Family Incm Lmt Free Care150.000000000000FPGFamilyIncmLmtFreeCarePct
FPG Family Incm Lmt Dscnt Care175.000000000000FPGFamilyIncmLmtDscntCarePct
Asset Level CriteriaYes (X)AssetLevelCriteriaInd
Medical Indigency CriteriaYes (X)MedicalIndigencyCriteriaInd
Insurance Status CriteriaYes (X)InsuranceStatusCriteriaInd
Underinsurance Stat CriteriaYes (X)UnderinsuranceStatCriteriaInd
Explained BasisYes (true)ExplainedBasisInd
App Financial Asst ExplnYes (true)AppFinancialAsstExplnInd
Described InfoYes (X)DescribedInfoInd
Described Suprt DocYes (X)DescribedSuprtDocInd
Provided Hospital ContactYes (X)ProvidedHospitalContactInd
Provided Nonprofit ContactYes (X)ProvidedNonprofitContactInd
Includes Publicity MeasuresYes (true)IncludesPublicityMeasuresInd
FAP Avlbl On Request No ChargeYes (X)FAPAvlblOnRequestNoChargeInd
FAP App Avlbl On Request No ChrgYes (X)FAPAppAvlblOnRequestNoChrgInd
Notified FAP Copy Bill DisplayYes (X)NotifiedFAPCopyBillDisplayInd
Communtity Notified FAPYes (X)CommuntityNotifiedFAPInd
FAP TranslatedYes (X)FAPTranslatedInd
Other PublicityYes (X)OtherPublicityInd
FAP Actions On NonpaymentYes (true)FAPActionsOnNonpaymentInd
Permit No ActionsYes (X)PermitNoActionsInd
Collection ActivitiesfalseCollectionActivitiesInd
Nondis Emergency Care PolicyYes (true)NondisEmergencyCarePolicyInd
Prospective Medicare MedicaidYes (X)ProspectiveMedicareMedicaidInd
Amounts Generally BilledfalseAmountsGenerallyBilledInd
Gross ChargesfalseGrossChargesInd

Supplemental Information SupplementalInformationGrp (4 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
FACILITY 1, COTEAU DES PRAIRIES - PART V, LINE 3ETHE FIVE PRIORITY NEEDS IDENTIFIED INCLUDE; 1) ACCESS TO CARE, CLOSE TO HOME, 2) ACCESS TO MENTAL HEALTH CARE, 3) ALCOHOL AND DRUG USE/ABUSE, 4) SUICIDE PREVENTION AND 5) PHYSICIAN/SPECIALIST REQRUITMENT.
FACILITY 1, COTEAU DES PRAIRIES - PART V, LINE 5THE HOSPITAL CONDUCTED COMMUNITY SURVEYS ONLINE AND IN PERSON, AND CONDUCTED AN INTERNAL STAKE HOLDER SURVEY. THERE WERE ALSO COMMUNITY AND ELITE INTERVIEWS WITH SWO, HIS, COMMUNITY LEADERS OF SERVICE AREAS AND EMERGENCY MEDICAL PERSONNEL, COMMUNITY MEMBERS, AND MEDICAL PRACTITIONERS.
FACILITY 1, COTEAU DES PRAIRIES - PART V, LINE 11THE FOLLOWING NEEDS WILL NOT BE ADDRESSED DUE TO OTHER ORGANIZATIONS IN THE COMMUNITY ADDRESSING. 1. TEEN PREGNANCY/UNSAFE SEX: SEVERAL KEY CONSTITUENT GROUPS WITHIN THE COMMUNITY HAVE ESTABLISHED PROGRAMS THAT ADDRESS THESE ISSUES. 2. AFFORDABLE HEALTH CARE: AFFORDABLE HEALTH CARE IS A NATIONAL ISSUE - ONE MUCH LARGER THAN CAN BE ADEQUATELY ADDRESSED BY A SMALL, CRITICAL ACCESS HOSPITAL. 3. ECONOMIC DEVELOPMENT/AFFORDABLE HOUSING: ACTIVITIES ARE UNDERWAY IN THE COMMUNITY THAT ADEQUATELY ADDRESS THE NEED EXPRESSED BY THE COMMUNITY MEMBERS THROUGHOUT THIS ASSESMENT.
FACILITY 1, COTEAU DES PRAIRIES - PART V, LINE 16JA SUMMARY OF THE CHARITY CARE POLICY IS POSTED IN THE HOSPITAL'S MAIN ENTRANCE/ADMISSION AREAS, THE MAIN ENTRANCE/ADMISSION AREAS FOR EACH OF THE CLINICS, AND IN THE EMERGENCY ROOMS AND WAITING ROOMS. CDPH PROVIDES A COPY OF THE POLICY, OR A SUMMARY THEREOF, AND FINANCIAL ASSISTANCE CONTACT INFORMATION TO PATIENTS AS PART OF THE INTAKE PROCESS, WHEN APPLICABLE. IN ADDITION, CDPH PERSONNEL DISCUSS WITH THE PATIENT THE AVAILABILITY OF VARIOUS GOVERNMENT BENEFITS, SUCH AS MEDICAID OR STATE PROGRAMS, AND ASSIST THE PATIENT WITH QUALIFICATION FOR SUCH PROGRAMS, WHEN APPLICABLE.
FieldValueIRS element (for citing)
Facility5FacilityNum

Oth Hlth Care Fclts Not Hospital OthHlthCareFcltsNotHospitalGrp

Oth Hlth Care Fclts OthHlthCareFcltsGrp (5 entries)

Address Line1USAddress/AddressLine1TxtCityUSAddress/CityNmState AbbreviationUSAddress/StateAbbreviationCdZIPUSAddress/ZIPCdFacilityFacilityTxt
BROWNS VALLEY CLINIC
106 4TH STREET SOUTHBROWNS VALLEYMN56219FAMILY PRACTICE CLINIC
ROSHOLT CLINIC
116 WEST MAIN STREETROSHOLTSD57260FAMILY PRACTICE CLINIC
HERMAN CLINIC
204 5TH ST EASTHERMANMN56248FAMILY PRACTICE CLINIC
SISSETON CLINIC
205 ORCHARD DRIVESISSETONSD57262FAMILY PRACTICE CLINIC
TEKAKWITHA LIVING CENTER INC
6 CHESTNUT STSISSETONSD57262LONG-TERM CARE FACILITY

Supplemental Information Detail SupplementalInformationDetail (11 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
PART I, LINE 7, COLUMN (F) - EXCLUSIONS FROM PERCENT OF TOTAL EXPENSENO BAD DEBT EXPENSE IS INCLUDED ON FORM 990, PART IX, LINE 25, COLUMN (A) AS BAD DEBT EXPENSE OF 1,043,961 IS REPORTED WITH NET PATIENT SERVICE REVENUE ON FORM 990, PART VIII, LINE 2.A., CONSISTENT WITH THE FINANCIAL STATEMENTS.
PART I, LINE 7 - COSTING METHODOLOGY EXPLANATIONCHARITY 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. COMMUNITY HEALTH IMPROVEMENT SERVICES, LINE 7E, IS COMPILED USING ACTUAL COSTS.
PART III, LINE 2 - BAD DEBT EXPENSE METHODOLOGYOVERALL COST TO CHARGE RATIO WAS USED TO DETERMINE AMOUNTS REPORTED ON SCHEDULE H, PART III, LINE 2. BAD DEBT EXPENSE REPORTED ON FORM 990, PART VIII, LINE 2A WAS 1,043,961.
PART III, LINE 3 BAD DEBT EXPENSE, PATIENTS ELIGIBLE FOR ASSISTANCEBAD DEBT EXPENSE ATTRIBUTABLE TO CHARITY CARE IS ESTIMATED BASED ON INCOME LEVELS AND ETHNICITY IN THIS AREA. MORE THAN 50% OF CDPH CHARGES ARE GENERATED BY THE NATIVE AMERICAN POPULATION. STATISTICS SHOW THE AVERAGE HOUSEHOLD INCOME OF NATIVE AMERICAN FAMILIES IN ROBERTS COUNTY IS TWO- THIRDS OF THAT OF OTHER ETHNIC GROUPS. VIRTUALLY ALL NATIVE AMERICANS QUALIFY FOR CHARITY CARE, THUS THE ORGANIZATION ESTIMATES APPROXIMATELY 50% OF BAD DEBT IS ATTRIBUTABLE TO PERSONS WHO WOULD QUALIFY FOR CHARITY CARE.
BAD DEBT EXPENSE FOOTNOTE TO FINANCIAL STATEMENTSTHE FOOTNOTE TO THE ORGANIZATION'S FINANCIAL STATEMENTS CAN BE FOUND ON PAGE 11 OF THE ATTACHED AUDITED FINANCIAL STATEMENTS.
PART III, LINE 8 - MEDICARE EXPLANATIONTHE HOSPITAL PROVIDES SERVICES TO MEDICARE PATIENTS KNOWING THERE COULD BE A SHORTFALL BECAUSE ACCESS TO HEALTHCARE AND INDIVIDUAL'S HEALTH IS IMPORTANT TO THE HOSPITAL. THEREFORE; THE MEDICARE SHORTFALL IS CONSIDERED A COMMUNITY BENEFIT. TOTAL REVENUE RECEIVED FROM MEDICARE (INCLUDING DSH AND IME) IS THE GROSS REIMBURSEMENT PLUS SETTLEMENT (INCLUDING LSA). BOTH THE TOTAL REVENUE RECEIVED FROM MEDICARE AND THE MEDICARE ALLOWABLE COSTS ARE REPORTED FROM THE MEDICARE COST REPORT. THE MEDICARE COST REPORT IS COMPLETED BASED ON THE RULES AND REGULATIONS SET FORTH BY CENTERS FOR MEDICAID AND MEDICARE SERVICES.
PART III, LINE 9B - COLLECTION PRACTICES EXPLANATIONFOR PATIENTS WHO QUALIFY FOR CHARITY CARE AND ARE COOPERATING IN GOOD FAITH TO RESOLVE THEIR DISCOUNTED HOSPITAL BILLS, COTEAU DES PRAIRIES HOSPITAL AND CLINIC MAY OFFER EXTENDED PAYMENT PLANS. THE HOSPITAL WILL NOT SEND UNPAID BILLS TO OUTSIDE COLLECTION AGENCIES AND WILL CEASE ALL COLLECTION ACTIONS SUCH AS WAGE GARNISHMENTS, LIENS ON PRIMARY RESIDENCES, OR OTHER LEGAL ACTIONS. THE HOSPITAL WILL FIRST MAKE REASONABLE EFFORTS TO DETERMINE WHETHER THE PATIENT IS ELIGIBLE FOR CHARITY CARE UNDER THE FINANCIAL ASSISTANCE POLICY.
PART VI, LINE 2 - NEEDS ASSESSMENTTHE PRIORITY OF CDPH IS TO PROMOTE THE HEALTH OF SISSETON AND ALSO THE SURROUNDING RURAL COMMUNITIES. PLEASE REFER TO SCHEDULE H, PART V, LINE 5.
PART VI, LINE 3 - PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCECDPH UTILIZES MULTIPLE METHODS FOR PATIENT EDUCATION OF FINANCIAL ASSISTANCE. PLEASE SEE SCHEDULE H, PART V, LINE 16.
PART VI, LINE 5 - PROMOTION OF COMMUNITY HEALTHCDPH IS A SOLE COMMUNITY PROVIDER WITH AN 8 MEMBER VOLUNTEER BOARD OF DIRECTORS WHO ALL RESIDE IN THE PRIMARY SERVICE AREA. MEDICAL STAFF PRIVILEGES ARE EXTENDED TO ALL QUALIFIED INDIVIDUALS AS THEY ARE REQUESTED. IF CDPH WERE TO HAVE SURPLUS FUNDS, THE FUNDS WOULD BE APPLIED TO PATIENT CARE IMPROVEMENTS AND ALSO TO REDUCE THE NEED FOR RATE INCREASES FOR THE PATIENTS. THE EMERGENCY ROOM IS STAFFED 24 HOURS A DAY, 7 DAYS A WEEK, AND PATIENTS ARE WELCOMED REGARDLESS OF RACE OR THE ABILITY TO PAY FOR THE SERVICES. CDPH PARTICIPATES IN ALL GOVERNMENT-SPONSORED HEALTH PROGRAMS INCLUDING MEDICARE, MEDICAID, INDIAN HEALTH SERVICES, AND VETERAN AFFAIRS BENEFITS. THE HOSPITAL AND CLINICS WELCOME STUDENTS FOR TRAINING AND COLLEGE ROTATIONS IN VARIOUS HEALTHCARE PROFESSIONS.
ADDITIONAL INFORMATIONPART I, LINE 3C: PLEASE REFER TO SCHEDULE H, PART V, LINE 13.

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Compensation CommitteeYes (X)CompensationCommitteeInd
Written Employment ContractYes (X)WrittenEmploymentContractInd
Compensation SurveyYes (X)CompensationSurveyInd
Board Or Committee ApprovalYes (X)BoardOrCommitteeApprovalInd
Severance PaymentfalseSeverancePaymentInd
Supplemental Nonqual Rtr PlanfalseSupplementalNonqualRtrPlanInd
Equity Based Comp ArrngmfalseEquityBasedCompArrngmInd
Comp Based On Revenue Of Flng OrgYes (true)CompBasedOnRevenueOfFlngOrgInd
Comp Bsd On Rev Related OrgsfalseCompBsdOnRevRelatedOrgsInd
Comp Bsd Net Earns Flng OrgfalseCompBsdNetEarnsFlngOrgInd
Comp Bsd Net Earns Rltd OrgsfalseCompBsdNetEarnsRltdOrgsInd
Any Non Fixed PaymentsfalseAnyNonFixedPaymentsInd
Initial Contract ExceptionfalseInitialContractExceptionInd

Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (6 entries)

TitleTitleTxtBase Compensation Filing OrgBaseCompensationFilingOrgAmtDeferred Compensation Flng OrgDeferredCompensationFlngOrgAmtNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmtTotal Compensation Filing OrgTotalCompensationFilingOrgAmt
MICHAEL COYLE
CEO$170,014$6,852$30,920$207,786
SHERRYL TOMBOULIAN MD
FAMILY PRACTICE$413,337$10,800$21,865$446,002
STANLEY GALLAGER DO
OSTEOPATHY$384,000$10,800$15,416$410,216
RAMON MORALES MD
GENERAL SURGEON$356,312$10,800$21,844$388,956
JUDY BEUMER MD
EMERGENCY MEDICINE$352,792$10,800$15,329$378,921
DAVID MEADOWS MD
FAMILY PRACTICE$300,535$10,800$1,103$312,438

Supplemental Information Detail SupplementalInformationDetail

FieldValueIRS element (for citing)
Form And Line ReferenceSCHEDULE J, PAGE 1, PART I, LINE 5AFormAndLineReferenceDesc
ExplanationTHREE PHYSICIANS ARE PAID 38% OF THEIR RESPECTIVE PROVIDER/CPT CODE REVENUE. OTHER PHYSICIANS AND MID-LEVEL PROVIDERS ARE PAID UNDER PRIOR CONTRACTS NOT RELATED TO THE REVENUE GENERATED.ExplanationTxt

Schedule K IRS990ScheduleK

Tax Exempt Bonds Issues TaxExemptBondsIssuesGrp

FieldValueIRS element (for citing)
Bond ReferenceABondReferenceCd

Issuer Name IssuerName

FieldValueIRS element (for citing)
Business Name Line1CITY OF SISSETON SOUTH DAKOTABusinessNameLine1Txt
FieldValueIRS element (for citing)
Bond Issuer EIN466000460BondIssuerEIN
Bond Issued2012-07-06BondIssuedDt
Issue Price$7,450,000IssuePriceAmt
PurposeFUND HOSPITAL REMODELING AND BUILDING ADDITION PROJECT.PurposeDesc
DefeasedfalseDefeasedInd
On Behalf Of IssuerfalseOnBehalfOfIssuerInd
Pool FinancingfalsePoolFinancingInd

Tax Exempt Bonds Proceeds TaxExemptBondsProceedsGrp

FieldValueIRS element (for citing)
Bond ReferenceABondReferenceCd
Retired$804,064RetiredAmt
Total Proceeds$7,450,000TotalProceedsAmt
Issuance Costs From Proceeds$122,280IssuanceCostsFromProceedsAmt
Capital Expenditures$7,077,281CapitalExpendituresAmt
Other Spent Proceeds$191,129OtherSpentProceedsAmt
Substantial Completion2014SubstantialCompletionYr
Current RefundingfalseCurrentRefundingInd
Advance RefundingfalseAdvanceRefundingInd
Final Allocation MadefalseFinalAllocationMadeInd
Adequate Books And Rec MaintYes (true)AdequateBooksAndRecMaintInd

Tax Exempt Bonds Private Bus Use TaxExemptBondsPrivateBusUseGrp

FieldValueIRS element (for citing)
Bond ReferenceABondReferenceCd
Owning Bond Financed PropertyfalseOwningBondFinancedPropertyInd
Any Lease ArrangementsfalseAnyLeaseArrangementsInd
Mgmt Contract Bond Fincd PropfalseMgmtContractBondFincdPropInd
Any Research AgreementsfalseAnyResearchAgreementsInd
Bond Iss Meet Prvt Sec Pymt TestfalseBondIssMeetPrvtSecPymtTestInd
Change In Use Bond Financed PropfalseChangeInUseBondFinancedPropInd
Procs Nonqualified Bond RemdtdYes (true)ProcsNonqualifiedBondRemdtdInd

Tax Exempt Bonds Arbitrage TaxExemptBondsArbitrageGrp

FieldValueIRS element (for citing)
Bond ReferenceABondReferenceCd
Form8038 T FiledfalseForm8038TFiledInd
Rebate Not Due YetfalseRebateNotDueYetInd
Exception To RebatefalseExceptionToRebateInd
No Rebate DuefalseNoRebateDueInd
Variable Rate IssuefalseVariableRateIssueInd
Hedge Identified In Bks And RecfalseHedgeIdentifiedInBksAndRecInd
Gross Proceeds Invested In GICfalseGrossProceedsInvestedInGICInd
Gross Proceeds InvestedfalseGrossProceedsInvestedInd
Written Proc To Monitor ReqsYes (true)WrittenProcToMonitorReqsInd

Procedures Corrective Action ProceduresCorrectiveActionGrp

FieldValueIRS element (for citing)
Bond ReferenceABondReferenceCd
Procedures Corrective ActionfalseProceduresCorrectiveActionInd

Supplemental Information Detail SupplementalInformationDetail

FieldValueIRS element (for citing)
Form And Line ReferenceSCHEDULE K - ADDITIONAL INFORMATIONFormAndLineReferenceDesc
ExplanationCITY OF SISSETON, SOUTH DAKOTA SCHEDULE K, PART I, BOND ISSUES: (A) ISSUER NAME: CITY OF SISSETON, SOUTH DAKOTA (F) DESCRIPTION OF PURPOSE: FUND HOSPITAL REMODELING AND BUILDING ADDITION PROJECTExplanationTxt

Schedule O IRS990ScheduleO

Supplemental Information Detail SupplementalInformationDetail (9 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
FORM 990, PAGE 2, PART III, LINE 4ASTATISTICS FOR THE PERIOD ENDED DECEMBER 31, 2017, ARE AS FOLLOWS: ACUTE PATIENT DAYS = 1,165, SWING-BED PATIENT DAYS = 464, NEWBORN NURSERY DAYS = 232, EMERGENCY ROOM VISITS = 4,248, CLINIC VISITS = 18,499, AND NUMEROUS OTHER OUTPATIENT VISITS.
FORM 990, PART VISECTION A, LINE 1: THE EXECUTIVE COMMITTEE CONSISTS OF THE PRESIDENT, VICE PRESIDENT, THE SECRETARY, THE TREASURER, AND ONE OTHER MEMBER OF THE BOARD TO BE ELECTED BY THE BOARD AT THE ANNUAL MEETING. THE EXECUTIVE COMMITTEE HAS THE POWER TO TRANSACT ALL REGULAR BUSINESS OF THE HOSPITAL & CLINIC DURING THE PERIOD BETWEEN THE MEETINGS OF THE BOARD. SUBJECT TO ANY PRIOR LIMITATION IMPOSED BY THE BOARD AND WITH THE UNDERSTANDING THAT ALL MATTERS OF MAJOR IMPORTANCE WILL BE REFERRED TO THE BOARD. MINUTES OF THE EXECUTIVE COMMITTEE MEETINGS ARE AVAILABLE TO THE BOARD.
FORM 990, PAGE 6, PART VI, LINE 11BTHE BOARD OF DIRECTORS RECEIVES A COPY OF THE FORM 990 PRIOR TO FILING. THE INTERIM CEO/COO REVIEWS THE 990 IN DETAIL.
FORM 990, PAGE 6, PART VI, LINE 12CTHE CONFLICT OF INTEREST POLICY IS COMPLETED ANNUALLY AND COVERS OFFICERS AND BOARD MEMBERS. THE BOARD IS GIVEN A CONFLICT OF INTEREST POLICY ON AN ANNUAL BASIS TO SIGN. THE DETERMINATION OF WHETHER A CONFLICT EXISTS IS MADE AT THE BOARD OF THE DIRECTORS LEVEL, AS IS THE REVIEW OF ACTUAL CONFLICTS. ANY PERSON DETERMINED TO HAVE A CONFLICT WILL HAVE AN OPPORTUNITY TO EXPLAIN THE SITUTATION, AND HE/SHE WILL BE REQUIRED TO REFRAIN FROM VOTING.
FORM 990, PAGE 6, PART VI, LINE 15ACOMPENSATION FOR THE CEO IS DETERMINED THROUGH INDIVIDUAL NEGOTIATIONS WITH THE EXECUTIVE COMMITTEE AND THE CEO. THE EXECUTIVE COMMITTEE USES SALARY SURVEYS TO DETERMINE WHAT CONSTITUTES REASONABLE COMPENSATION. NEGOTIATIONS WITH THE EXECUTIVE COMMITTEE INCLUDE A PERFORMANCE EVALUATION. AN EVALUATION IS DONE ANNUALLY BY THE EXECUTIVE COMMITTEE, AND APPROVED BY THE BOARD OF DIRECTORS.
FORM 990, PAGE 6, PART VI, LINE 15BCOMPENSATION OF THE CDPH'S OFFICERS IS DETERMINED THROUGH DISCUSSIONS BETWEEN THE EXECUTIVE COMMITTEE AND THE CEO. THE EXECUTIVE COMMITTEE USES SALARY SURVEYS TO DETERMINE WHAT CONSTITUTES REASONABLE COMPENSATION. DISCUSSIONS WITH THE EXECUTIVE COMMITTEE INCLUDE A PERFORMANCE EVALUATION. AN EVALUATION IS DONE ANNUALLY BY THE EXECUTIVE COMMITTEE, AND APPROVED BY THE BOARD OF DIRECTORS.
FORM 990, PAGE 6, PART VI, LINE 19THE GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS ARE AVAILABLE UPON REQUEST.
FORM 990, PART IX, LINE 11GPURCHASED SERVICES 745,150 416,251 0 REPAIRS & MAINTENANCE 264,917 196,769 0 PROFESSIONAL FEES 941,243 13,528 0 COLLECTION FEES 0 78,909 0 CONTRACT LABOR 201,470 6,193 0 TOTAL 2,152,780 711,650 0
FORM 990, PART XI, LINE 9NET ASSETS RELEASED FROM RESTRICTION -22,730

Schedule R IRS990ScheduleR

Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (2 entries)

Address Line1USAddress/AddressLine1TxtCityUSAddress/CityNmState AbbreviationUSAddress/StateAbbreviationCdZIPUSAddress/ZIPCdEINEINPrimary ActivitiesPrimaryActivitiesTxtLegal Domicile StateLegalDomicileStateCdExempt Code SectionExemptCodeSectionTxtPublic Charity StatusPublicCharityStatusTxtDirect Controlling NADirectControllingNACdControlled OrganizationControlledOrganizationInd
COTEAU DES PRAIRIES FOUNDATION
205 ORCHARD DRIVESISSETONSD572622398800446054FUNDRAISESD501C37N/Afalse
TEKAKWITHA NURSING CENTER INC
6 E CHESTNUT STSISSETONSD57262411809912LTCSD501C310N/Afalse
FieldValueIRS element (for citing)
Receipt Of Int Annts Rnts RyltsfalseReceiptOfIntAnntsRntsRyltsInd
Gift Grnt Or Cap Contri To Oth OrgfalseGiftGrntOrCapContriToOthOrgInd
Gift Grnt Cap Contri From Oth OrgYes (true)GiftGrntCapContriFromOthOrgInd
Loans Or Guarantees To Other OrgfalseLoansOrGuaranteesToOtherOrgInd
Loans Or Guarantees From Oth OrgfalseLoansOrGuaranteesFromOthOrgInd
Div Related OrganizationfalseDivRelatedOrganizationInd
Asset Sale To Other OrgfalseAssetSaleToOtherOrgInd
Asset Purchase From Other OrgfalseAssetPurchaseFromOtherOrgInd
Asset ExchangefalseAssetExchangeInd
Rental Of Facilities To Oth OrgfalseRentalOfFacilitiesToOthOrgInd
Rental Of Fclts From Oth OrgfalseRentalOfFcltsFromOthOrgInd
Perform Of Services For Oth OrgfalsePerformOfServicesForOthOrgInd
Perform Of Services By Other OrgfalsePerformOfServicesByOtherOrgInd
Sharing Of FacilitiesfalseSharingOfFacilitiesInd
Paid Employees SharingfalsePaidEmployeesSharingInd
Reimbursement Paid To Other OrgfalseReimbursementPaidToOtherOrgInd
Reimbursement Paid By Other OrgfalseReimbursementPaidByOtherOrgInd
Transfer To Other OrgfalseTransferToOtherOrgInd
Transfer From Other OrgfalseTransferFromOtherOrgInd

Transactions Related Org TransactionsRelatedOrgGrp

Other Organization Name OtherOrganizationName

FieldValueIRS element (for citing)
Business Name Line1COTEAU DES PRAIRIES FOUNDATIONBusinessNameLine1Txt
FieldValueIRS element (for citing)
Transaction TypeCTransactionTypeTxt
Involved$3,290InvolvedAmt
Method Of Amount DeterminationCASHMethodOfAmountDeterminationTxt

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