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        <ExplanationTxt>THE 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.</ExplanationTxt>
      </SupplementalInformationGrp>
      <SupplementalInformationGrp>
        <FormAndLineReferenceDesc>FACILITY 1, COTEAU DES PRAIRIES - PART V, LINE 5</FormAndLineReferenceDesc>
        <ExplanationTxt>THE 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.</ExplanationTxt>
      </SupplementalInformationGrp>
      <SupplementalInformationGrp>
        <FormAndLineReferenceDesc>FACILITY 1, COTEAU DES PRAIRIES - PART V, LINE 11</FormAndLineReferenceDesc>
        <ExplanationTxt>THE 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.</ExplanationTxt>
      </SupplementalInformationGrp>
      <SupplementalInformationGrp>
        <FormAndLineReferenceDesc>FACILITY 1, COTEAU DES PRAIRIES - PART V, LINE 16J</FormAndLineReferenceDesc>
        <ExplanationTxt>A 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.</ExplanationTxt>
      </SupplementalInformationGrp>
      <FacilityNum>5</FacilityNum>
      <OthHlthCareFcltsNotHospitalGrp>
        <OthHlthCareFcltsGrp>
          <BusinessName>
            <BusinessNameLine1Txt>BROWNS VALLEY CLINIC</BusinessNameLine1Txt>
          </BusinessName>
          <USAddress>
            <AddressLine1Txt>106 4TH STREET SOUTH</AddressLine1Txt>
            <CityNm>BROWNS VALLEY</CityNm>
            <StateAbbreviationCd>MN</StateAbbreviationCd>
            <ZIPCd>56219</ZIPCd>
          </USAddress>
          <FacilityTxt>FAMILY PRACTICE CLINIC</FacilityTxt>
        </OthHlthCareFcltsGrp>
        <OthHlthCareFcltsGrp>
          <BusinessName>
            <BusinessNameLine1Txt>ROSHOLT CLINIC</BusinessNameLine1Txt>
          </BusinessName>
          <USAddress>
            <AddressLine1Txt>116 WEST MAIN STREET</AddressLine1Txt>
            <CityNm>ROSHOLT</CityNm>
            <StateAbbreviationCd>SD</StateAbbreviationCd>
            <ZIPCd>57260</ZIPCd>
          </USAddress>
          <FacilityTxt>FAMILY PRACTICE CLINIC</FacilityTxt>
        </OthHlthCareFcltsGrp>
        <OthHlthCareFcltsGrp>
          <BusinessName>
            <BusinessNameLine1Txt>HERMAN CLINIC</BusinessNameLine1Txt>
          </BusinessName>
          <USAddress>
            <AddressLine1Txt>204 5TH ST EAST</AddressLine1Txt>
            <CityNm>HERMAN</CityNm>
            <StateAbbreviationCd>MN</StateAbbreviationCd>
            <ZIPCd>56248</ZIPCd>
          </USAddress>
          <FacilityTxt>FAMILY PRACTICE CLINIC</FacilityTxt>
        </OthHlthCareFcltsGrp>
        <OthHlthCareFcltsGrp>
          <BusinessName>
            <BusinessNameLine1Txt>SISSETON CLINIC</BusinessNameLine1Txt>
          </BusinessName>
          <USAddress>
            <AddressLine1Txt>205 ORCHARD DRIVE</AddressLine1Txt>
            <CityNm>SISSETON</CityNm>
            <StateAbbreviationCd>SD</StateAbbreviationCd>
            <ZIPCd>57262</ZIPCd>
          </USAddress>
          <FacilityTxt>FAMILY PRACTICE CLINIC</FacilityTxt>
        </OthHlthCareFcltsGrp>
        <OthHlthCareFcltsGrp>
          <BusinessName>
            <BusinessNameLine1Txt>TEKAKWITHA LIVING CENTER INC</BusinessNameLine1Txt>
          </BusinessName>
          <USAddress>
            <AddressLine1Txt>6 CHESTNUT ST</AddressLine1Txt>
            <CityNm>SISSETON</CityNm>
            <StateAbbreviationCd>SD</StateAbbreviationCd>
            <ZIPCd>57262</ZIPCd>
          </USAddress>
          <FacilityTxt>LONG-TERM CARE FACILITY</FacilityTxt>
        </OthHlthCareFcltsGrp>
      </OthHlthCareFcltsNotHospitalGrp>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>PART I, LINE 7, COLUMN (F) - EXCLUSIONS FROM PERCENT OF TOTAL EXPENSE</FormAndLineReferenceDesc>
        <ExplanationTxt>NO 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.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>PART I, LINE 7 - COSTING METHODOLOGY EXPLANATION</FormAndLineReferenceDesc>
        <ExplanationTxt>CHARITY 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.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>PART III, LINE 2 - BAD DEBT EXPENSE METHODOLOGY</FormAndLineReferenceDesc>
        <ExplanationTxt>OVERALL 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.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>PART III, LINE 3 BAD DEBT EXPENSE, PATIENTS ELIGIBLE FOR ASSISTANCE</FormAndLineReferenceDesc>
        <ExplanationTxt>BAD 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.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>BAD DEBT EXPENSE FOOTNOTE TO FINANCIAL STATEMENTS</FormAndLineReferenceDesc>
        <ExplanationTxt>THE FOOTNOTE TO THE ORGANIZATION'S FINANCIAL STATEMENTS CAN BE FOUND ON PAGE 11 OF THE ATTACHED AUDITED FINANCIAL STATEMENTS.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>PART III, LINE 8 - MEDICARE EXPLANATION</FormAndLineReferenceDesc>
        <ExplanationTxt>THE 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.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>PART III, LINE 9B - COLLECTION PRACTICES EXPLANATION</FormAndLineReferenceDesc>
        <ExplanationTxt>FOR 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.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>PART VI, LINE 2 - NEEDS ASSESSMENT</FormAndLineReferenceDesc>
        <ExplanationTxt>THE 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.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>PART VI, LINE 3 - PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE</FormAndLineReferenceDesc>
        <ExplanationTxt>CDPH UTILIZES MULTIPLE METHODS FOR PATIENT EDUCATION OF FINANCIAL ASSISTANCE. PLEASE SEE SCHEDULE H, PART V, LINE 16.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>PART VI, LINE 5 - PROMOTION OF COMMUNITY HEALTH</FormAndLineReferenceDesc>
        <ExplanationTxt>CDPH 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.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>ADDITIONAL INFORMATION</FormAndLineReferenceDesc>
        <ExplanationTxt>PART I, LINE 3C: PLEASE REFER TO SCHEDULE H, PART V, LINE 13.</ExplanationTxt>
      </SupplementalInformationDetail>
    </IRS990ScheduleH>
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      <WrittenEmploymentContractInd>X</WrittenEmploymentContractInd>
      <CompensationSurveyInd>X</CompensationSurveyInd>
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      <SeverancePaymentInd>false</SeverancePaymentInd>
      <SupplementalNonqualRtrPlanInd>false</SupplementalNonqualRtrPlanInd>
      <EquityBasedCompArrngmInd>false</EquityBasedCompArrngmInd>
      <CompBasedOnRevenueOfFlngOrgInd>true</CompBasedOnRevenueOfFlngOrgInd>
      <CompBsdOnRevRelatedOrgsInd>false</CompBsdOnRevRelatedOrgsInd>
      <CompBsdNetEarnsFlngOrgInd>false</CompBsdNetEarnsFlngOrgInd>
      <CompBsdNetEarnsRltdOrgsInd>false</CompBsdNetEarnsRltdOrgsInd>
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      <InitialContractExceptionInd>false</InitialContractExceptionInd>
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        <PersonNm>MICHAEL COYLE</PersonNm>
        <TitleTxt>CEO</TitleTxt>
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        <DeferredCompensationFlngOrgAmt>6852</DeferredCompensationFlngOrgAmt>
        <NontaxableBenefitsFilingOrgAmt>30920</NontaxableBenefitsFilingOrgAmt>
        <TotalCompensationFilingOrgAmt>207786</TotalCompensationFilingOrgAmt>
      </RltdOrgOfficerTrstKeyEmplGrp>
      <RltdOrgOfficerTrstKeyEmplGrp>
        <PersonNm>SHERRYL TOMBOULIAN MD</PersonNm>
        <TitleTxt>FAMILY PRACTICE</TitleTxt>
        <BaseCompensationFilingOrgAmt>413337</BaseCompensationFilingOrgAmt>
        <DeferredCompensationFlngOrgAmt>10800</DeferredCompensationFlngOrgAmt>
        <NontaxableBenefitsFilingOrgAmt>21865</NontaxableBenefitsFilingOrgAmt>
        <TotalCompensationFilingOrgAmt>446002</TotalCompensationFilingOrgAmt>
      </RltdOrgOfficerTrstKeyEmplGrp>
      <RltdOrgOfficerTrstKeyEmplGrp>
        <PersonNm>STANLEY GALLAGER DO</PersonNm>
        <TitleTxt>OSTEOPATHY</TitleTxt>
        <BaseCompensationFilingOrgAmt>384000</BaseCompensationFilingOrgAmt>
        <DeferredCompensationFlngOrgAmt>10800</DeferredCompensationFlngOrgAmt>
        <NontaxableBenefitsFilingOrgAmt>15416</NontaxableBenefitsFilingOrgAmt>
        <TotalCompensationFilingOrgAmt>410216</TotalCompensationFilingOrgAmt>
      </RltdOrgOfficerTrstKeyEmplGrp>
      <RltdOrgOfficerTrstKeyEmplGrp>
        <PersonNm>RAMON MORALES MD</PersonNm>
        <TitleTxt>GENERAL SURGEON</TitleTxt>
        <BaseCompensationFilingOrgAmt>356312</BaseCompensationFilingOrgAmt>
        <DeferredCompensationFlngOrgAmt>10800</DeferredCompensationFlngOrgAmt>
        <NontaxableBenefitsFilingOrgAmt>21844</NontaxableBenefitsFilingOrgAmt>
        <TotalCompensationFilingOrgAmt>388956</TotalCompensationFilingOrgAmt>
      </RltdOrgOfficerTrstKeyEmplGrp>
      <RltdOrgOfficerTrstKeyEmplGrp>
        <PersonNm>JUDY BEUMER MD</PersonNm>
        <TitleTxt>EMERGENCY MEDICINE</TitleTxt>
        <BaseCompensationFilingOrgAmt>352792</BaseCompensationFilingOrgAmt>
        <DeferredCompensationFlngOrgAmt>10800</DeferredCompensationFlngOrgAmt>
        <NontaxableBenefitsFilingOrgAmt>15329</NontaxableBenefitsFilingOrgAmt>
        <TotalCompensationFilingOrgAmt>378921</TotalCompensationFilingOrgAmt>
      </RltdOrgOfficerTrstKeyEmplGrp>
      <RltdOrgOfficerTrstKeyEmplGrp>
        <PersonNm>DAVID MEADOWS MD</PersonNm>
        <TitleTxt>FAMILY PRACTICE</TitleTxt>
        <BaseCompensationFilingOrgAmt>300535</BaseCompensationFilingOrgAmt>
        <DeferredCompensationFlngOrgAmt>10800</DeferredCompensationFlngOrgAmt>
        <NontaxableBenefitsFilingOrgAmt>1103</NontaxableBenefitsFilingOrgAmt>
        <TotalCompensationFilingOrgAmt>312438</TotalCompensationFilingOrgAmt>
      </RltdOrgOfficerTrstKeyEmplGrp>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>SCHEDULE J, PAGE 1, PART I, LINE 5A</FormAndLineReferenceDesc>
        <ExplanationTxt>THREE 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>
      </SupplementalInformationDetail>
    </IRS990ScheduleJ>
    <IRS990ScheduleK documentId="RetDoc6">
      <TaxExemptBondsIssuesGrp>
        <BondReferenceCd>A</BondReferenceCd>
        <IssuerName>
          <BusinessNameLine1Txt>CITY OF SISSETON SOUTH DAKOTA</BusinessNameLine1Txt>
        </IssuerName>
        <BondIssuerEIN>466000460</BondIssuerEIN>
        <BondIssuedDt>2012-07-06</BondIssuedDt>
        <IssuePriceAmt>7450000</IssuePriceAmt>
        <PurposeDesc>FUND HOSPITAL REMODELING AND BUILDING ADDITION PROJECT.</PurposeDesc>
        <DefeasedInd>false</DefeasedInd>
        <OnBehalfOfIssuerInd>false</OnBehalfOfIssuerInd>
        <PoolFinancingInd>false</PoolFinancingInd>
      </TaxExemptBondsIssuesGrp>
      <TaxExemptBondsProceedsGrp>
        <BondReferenceCd>A</BondReferenceCd>
        <RetiredAmt>804064</RetiredAmt>
        <TotalProceedsAmt>7450000</TotalProceedsAmt>
        <IssuanceCostsFromProceedsAmt>122280</IssuanceCostsFromProceedsAmt>
        <CapitalExpendituresAmt>7077281</CapitalExpendituresAmt>
        <OtherSpentProceedsAmt>191129</OtherSpentProceedsAmt>
        <SubstantialCompletionYr>2014</SubstantialCompletionYr>
        <CurrentRefundingInd>false</CurrentRefundingInd>
        <AdvanceRefundingInd>false</AdvanceRefundingInd>
        <FinalAllocationMadeInd>false</FinalAllocationMadeInd>
        <AdequateBooksAndRecMaintInd>true</AdequateBooksAndRecMaintInd>
      </TaxExemptBondsProceedsGrp>
      <TaxExemptBondsPrivateBusUseGrp>
        <BondReferenceCd>A</BondReferenceCd>
        <OwningBondFinancedPropertyInd>false</OwningBondFinancedPropertyInd>
        <AnyLeaseArrangementsInd>false</AnyLeaseArrangementsInd>
        <MgmtContractBondFincdPropInd>false</MgmtContractBondFincdPropInd>
        <AnyResearchAgreementsInd>false</AnyResearchAgreementsInd>
        <BondIssMeetPrvtSecPymtTestInd>false</BondIssMeetPrvtSecPymtTestInd>
        <ChangeInUseBondFinancedPropInd>false</ChangeInUseBondFinancedPropInd>
        <ProcsNonqualifiedBondRemdtdInd>true</ProcsNonqualifiedBondRemdtdInd>
      </TaxExemptBondsPrivateBusUseGrp>
      <TaxExemptBondsArbitrageGrp>
        <BondReferenceCd>A</BondReferenceCd>
        <Form8038TFiledInd>false</Form8038TFiledInd>
        <RebateNotDueYetInd>false</RebateNotDueYetInd>
        <ExceptionToRebateInd>false</ExceptionToRebateInd>
        <NoRebateDueInd>false</NoRebateDueInd>
        <VariableRateIssueInd>false</VariableRateIssueInd>
        <HedgeIdentifiedInBksAndRecInd>false</HedgeIdentifiedInBksAndRecInd>
        <GrossProceedsInvestedInGICInd>false</GrossProceedsInvestedInGICInd>
        <GrossProceedsInvestedInd>false</GrossProceedsInvestedInd>
        <WrittenProcToMonitorReqsInd>true</WrittenProcToMonitorReqsInd>
      </TaxExemptBondsArbitrageGrp>
      <ProceduresCorrectiveActionGrp>
        <BondReferenceCd>A</BondReferenceCd>
        <ProceduresCorrectiveActionInd>false</ProceduresCorrectiveActionInd>
      </ProceduresCorrectiveActionGrp>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>SCHEDULE K - ADDITIONAL INFORMATION</FormAndLineReferenceDesc>
        <ExplanationTxt>CITY 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 PROJECT</ExplanationTxt>
      </SupplementalInformationDetail>
    </IRS990ScheduleK>
    <IRS990ScheduleO documentId="RetDoc7">
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>FORM 990, PAGE 2, PART III, LINE 4A</FormAndLineReferenceDesc>
        <ExplanationTxt>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.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>FORM 990, PART VI</FormAndLineReferenceDesc>
        <ExplanationTxt>SECTION 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 &amp; 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.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>FORM 990, PAGE 6, PART VI, LINE 11B</FormAndLineReferenceDesc>
        <ExplanationTxt>THE BOARD OF DIRECTORS RECEIVES A COPY OF THE FORM 990 PRIOR TO FILING. THE INTERIM CEO/COO REVIEWS THE 990 IN DETAIL.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>FORM 990, PAGE 6, PART VI, LINE 12C</FormAndLineReferenceDesc>
        <ExplanationTxt>THE 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.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>FORM 990, PAGE 6, PART VI, LINE 15A</FormAndLineReferenceDesc>
        <ExplanationTxt>COMPENSATION 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.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>FORM 990, PAGE 6, PART VI, LINE 15B</FormAndLineReferenceDesc>
        <ExplanationTxt>COMPENSATION 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.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>FORM 990, PAGE 6, PART VI, LINE 19</FormAndLineReferenceDesc>
        <ExplanationTxt>THE GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS ARE AVAILABLE UPON REQUEST.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>FORM 990, PART IX, LINE 11G</FormAndLineReferenceDesc>
        <ExplanationTxt>PURCHASED SERVICES 745,150 416,251 0 REPAIRS &amp; 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</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>FORM 990, PART XI, LINE 9</FormAndLineReferenceDesc>
        <ExplanationTxt>NET ASSETS RELEASED FROM RESTRICTION -22,730</ExplanationTxt>
      </SupplementalInformationDetail>
    </IRS990ScheduleO>
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          <BusinessNameLine1Txt>COTEAU DES PRAIRIES FOUNDATION</BusinessNameLine1Txt>
        </DisregardedEntityName>
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          <AddressLine1Txt>205 ORCHARD DRIVE</AddressLine1Txt>
          <CityNm>SISSETON</CityNm>
          <StateAbbreviationCd>SD</StateAbbreviationCd>
          <ZIPCd>572622398</ZIPCd>
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        <PublicCharityStatusTxt>7</PublicCharityStatusTxt>
        <DirectControllingNACd>N/A</DirectControllingNACd>
        <ControlledOrganizationInd>false</ControlledOrganizationInd>
      </IdRelatedTaxExemptOrgGrp>
      <IdRelatedTaxExemptOrgGrp>
        <DisregardedEntityName>
          <BusinessNameLine1Txt>TEKAKWITHA NURSING CENTER INC</BusinessNameLine1Txt>
        </DisregardedEntityName>
        <USAddress>
          <AddressLine1Txt>6 E CHESTNUT ST</AddressLine1Txt>
          <CityNm>SISSETON</CityNm>
          <StateAbbreviationCd>SD</StateAbbreviationCd>
          <ZIPCd>57262</ZIPCd>
        </USAddress>
        <EIN>411809912</EIN>
        <PrimaryActivitiesTxt>LTC</PrimaryActivitiesTxt>
        <LegalDomicileStateCd>SD</LegalDomicileStateCd>
        <ExemptCodeSectionTxt>501C3</ExemptCodeSectionTxt>
        <PublicCharityStatusTxt>10</PublicCharityStatusTxt>
        <DirectControllingNACd>N/A</DirectControllingNACd>
        <ControlledOrganizationInd>false</ControlledOrganizationInd>
      </IdRelatedTaxExemptOrgGrp>
      <ReceiptOfIntAnntsRntsRyltsInd>false</ReceiptOfIntAnntsRntsRyltsInd>
      <GiftGrntOrCapContriToOthOrgInd>false</GiftGrntOrCapContriToOthOrgInd>
      <GiftGrntCapContriFromOthOrgInd>true</GiftGrntCapContriFromOthOrgInd>
      <LoansOrGuaranteesToOtherOrgInd>false</LoansOrGuaranteesToOtherOrgInd>
      <LoansOrGuaranteesFromOthOrgInd>false</LoansOrGuaranteesFromOthOrgInd>
      <DivRelatedOrganizationInd>false</DivRelatedOrganizationInd>
      <AssetSaleToOtherOrgInd>false</AssetSaleToOtherOrgInd>
      <AssetPurchaseFromOtherOrgInd>false</AssetPurchaseFromOtherOrgInd>
      <AssetExchangeInd>false</AssetExchangeInd>
      <RentalOfFacilitiesToOthOrgInd>false</RentalOfFacilitiesToOthOrgInd>
      <RentalOfFcltsFromOthOrgInd>false</RentalOfFcltsFromOthOrgInd>
      <PerformOfServicesForOthOrgInd>false</PerformOfServicesForOthOrgInd>
      <PerformOfServicesByOtherOrgInd>false</PerformOfServicesByOtherOrgInd>
      <SharingOfFacilitiesInd>false</SharingOfFacilitiesInd>
      <PaidEmployeesSharingInd>false</PaidEmployeesSharingInd>
      <ReimbursementPaidToOtherOrgInd>false</ReimbursementPaidToOtherOrgInd>
      <ReimbursementPaidByOtherOrgInd>false</ReimbursementPaidByOtherOrgInd>
      <TransferToOtherOrgInd>false</TransferToOtherOrgInd>
      <TransferFromOtherOrgInd>false</TransferFromOtherOrgInd>
      <TransactionsRelatedOrgGrp>
        <OtherOrganizationName>
          <BusinessNameLine1Txt>COTEAU DES PRAIRIES FOUNDATION</BusinessNameLine1Txt>
        </OtherOrganizationName>
        <TransactionTypeTxt>C</TransactionTypeTxt>
        <InvolvedAmt>3290</InvolvedAmt>
        <MethodOfAmountDeterminationTxt>CASH</MethodOfAmountDeterminationTxt>
      </TransactionsRelatedOrgGrp>
    </IRS990ScheduleR>
  </ReturnData>
</Return>