DOUGLAS COUNTY MEMORIAL HOSPITAL: Form 990, tax year 2013
View the entire original 990 at ProPublica ↗
- Organization
- DOUGLAS COUNTY MEMORIAL HOSPITAL (EIN 46-0400557)
- Tax period
- 2013-06-01 to 2014-05-31
- Filed
- 2015-01-15
- IRS object ID
- 201510159349300346
- Schema version
- 2013v4.0
- 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
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2015-01-15T12:12:19-06:00 | ReturnTs |
| Tax Period End | 2014-05-31 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 460434947 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | ELO PROF LLC | BusinessNameLine1 |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO BOX 249 | AddressLine1 |
| City | MITCHELL | City |
| State | SD | State |
| ZIP Code | 57301 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2013-06-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 460400557 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | DOUGLAS COUNTY MEMORIAL HOSPITAL | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | DOUG | BusinessNameControlTxt |
| Phone | 6057242159 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 708 8TH STREET | AddressLine1 |
| City | ARMOUR | City |
| State | SD | State |
| ZIP Code | 573132102 | ZIPCode |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | HEATH BROUWER | PersonNm |
| Person Title | ADMINISTRATOR | PersonTitleTxt |
| Phone | 6057242159 | PhoneNum |
| Signature | 2015-01-13 | SignatureDt |
| Discuss With Paid Preparer | Yes (true) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | JAY TOLSMA CPA | PreparerPersonNm |
| PTIN | P00736087 | PTIN |
| Phone | 6059967717 | PhoneNum |
| Preparation | 2015-01-14 | PreparationDt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2013 | TaxYr |
| Build TS | 2016-02-25 16:41:14Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | HEATH BROUWER | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 708 8TH ST | AddressLine1 |
| City | ARMOUR | City |
| State | SD | State |
| ZIP Code | 57313 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $8,753,178 | GrossReceiptsAmt |
| Group Return For Affiliates | false | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | WWW.DCMHSD.ORG | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Activity Or Mission | PROMOTION OF GENERAL HEALTH CARE AND REHABILITATION SERVICES | ActivityOrMissionDesc |
| Voting Members Governing Body | 7 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 7 | VotingMembersIndependentCnt |
| Total Employee | 108 | TotalEmployeeCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| PY Contributions Grants | $580,760 | PYContributionsGrantsAmt |
| CY Contributions Grants | $41,071 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $7,754,004 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $8,521,144 | CYProgramServiceRevenueAmt |
| PY Investment Income | $4,469 | PYInvestmentIncomeAmt |
| CY Investment Income | $3,989 | CYInvestmentIncomeAmt |
| PY Other Revenue | $185,660 | PYOtherRevenueAmt |
| CY Other Revenue | $186,974 | CYOtherRevenueAmt |
| PY Total Revenue | $8,524,893 | PYTotalRevenueAmt |
| CY Total Revenue | $8,753,178 | CYTotalRevenueAmt |
| CY Grants And Similar Paid | $0 | CYGrantsAndSimilarPaidAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $4,152,660 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $4,463,120 | CYSalariesCompEmpBnftPaidAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $3,781,450 | PYOtherExpensesAmt |
| CY Other Expenses | $4,119,084 | CYOtherExpensesAmt |
| PY Total Expenses | $7,934,110 | PYTotalExpensesAmt |
| CY Total Expenses | $8,582,204 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $590,783 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $170,974 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $8,462,418 | TotalAssetsBOYAmt |
| Total Assets EOY | $11,145,535 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $2,262,242 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $4,774,385 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $6,200,176 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $6,371,150 | NetAssetsOrFundBalancesEOYAmt |
| Mission | PROMOTION OF GENERAL HEALTH CARE AND REHABILITATION SERVICES | MissionDesc |
| Significant New Program Srvc | false | SignificantNewProgramSrvcInd |
| Significant Change | false | SignificantChangeInd |
| Expense | $7,567,099 | ExpenseAmt |
| Desc | DOUGLAS COUNTY MEMORIAL HOSPITAL PROVIDES HEALTHCARE SERVICES TO PERSONS IN THE ARMOUR, CORSICA, STICKNEY, AND WAGNER COMMUNITIES. THE HOSPITAL PROVIDED 844 INPATIENT DAYS, 557 EMERGENCY ROOM VISITS, 9,412 OUTPATIENT VISITS AND 5,561 ASSISTED LIVING (PRAIRIE VILLA) DAYS. THE FACILITY PROVIDES HOME DELIVERED MEALS TO HOME-BOUND COMMUNITY MEMBERS ALONG WITH MEALS TO SENIOR MEALS PROGRAM. EACH PRAIRIE HEALTH CLINIC LOCATION CONDUCTS AN ANNUAL HEALTH FAIR. | Desc |
| Total Program Service Expenses | $7,567,099 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (true) | DescribedInSection501c3Ind |
| Schedule B Required | false | ScheduleBRequiredInd |
| Political Campaign Acty | false | PoliticalCampaignActyInd |
| Lobbying Activities | false | LobbyingActivitiesInd |
| Subject To Proxy Tax | false | SubjectToProxyTaxInd |
| Donor Advised Fund | false | DonorAdvisedFundInd |
| Conservation Easements | false | ConservationEasementsInd |
| Collections Of Art | false | CollectionsOfArtInd |
| Credit Counseling | false | CreditCounselingInd |
| Temp Or Permanent Endowments | false | TempOrPermanentEndowmentsInd |
| Report Land Building Equipment | Yes (true) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | false | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | false | ReportProgramRelatedInvstInd |
| Report Other Assets | false | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (true) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | false | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | Yes (true) | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | false | ConsolidatedAuditFinclStmtInd |
| School Operating | false | SchoolOperatingInd |
| Foreign Office | false | ForeignOfficeInd |
| Foreign Activities | false | ForeignActivitiesInd |
| More Than5000 K To Org | false | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | false | MoreThan5000KToIndividualsInd |
| Professional Fundraising | false | ProfessionalFundraisingInd |
| Fundraising Activities | false | FundraisingActivitiesInd |
| Gaming Activities | false | GamingActivitiesInd |
| Operate Hospital | Yes (true) | OperateHospitalInd |
| Audited Financial Stmt Att | Yes (true) | AuditedFinancialStmtAttInd |
| Grants To Organizations | false | GrantsToOrganizationsInd |
| Grants To Individuals | false | GrantsToIndividualsInd |
| Schedule J Required | Yes (true) | ScheduleJRequiredInd |
| Tax Exempt Bonds | false | TaxExemptBondsInd |
| Engaged In Excess Benefit Trans | false | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | false | PYExcessBenefitTransInd |
| Loan Outstanding | Yes (true) | LoanOutstandingInd |
| Grant To Related Person | false | GrantToRelatedPersonInd |
| Business Rln With Org Mem | false | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | false | BusinessRlnWithFamMemInd |
| Business Rln With Officer Ent | false | BusinessRlnWithOfficerEntInd |
| Deductible Non Cash Contri | false | DeductibleNonCashContriInd |
| Deductible Art Contribution | false | DeductibleArtContributionInd |
| Terminate Operations | false | TerminateOperationsInd |
| Partial Liquidation | false | PartialLiquidationInd |
| Disregarded Entity | false | DisregardedEntityInd |
| Related Entity | false | RelatedEntityInd |
| Related Organization Ctrl Ent | false | RelatedOrganizationCtrlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | false | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | false | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (true) | ScheduleORequiredInd |
| IRP Document | 22 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (true) | BackupWthldComplianceInd |
| Employee | 108 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (true) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | false | UnrelatedBusIncmOverLimitInd |
| Foreign Financial Account | false | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | false | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | false | TaxablePartyNotificationInd |
| Nondeductible Contributions | false | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | false | QuidProQuoContributionsInd |
| Form8282 Property Disposed Of | false | Form8282PropertyDisposedOfInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | false | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | false | PayPremiumsPrsnlBnftCntrctInd |
| Form8899 Filedind | false | Form8899Filedind |
| Form1098 C Filed | false | Form1098CFiledInd |
| Indoor Tanning Services | false | IndoorTanningServicesInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 7 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 7 | IndependentVotingMemberCnt |
| Family Or Business Rln | false | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | false | DelegationOfMgmtDutiesInd |
| Change To Org Documents | false | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | false | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | false | MembersOrStockholdersInd |
| Election Of Board Members | false | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | false | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (true) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (true) | MinutesOfCommitteesInd |
| Officer Mailing Address | false | OfficerMailingAddressInd |
| Local Chapters | false | LocalChaptersInd |
| Form990 Provided To Gvrn Body | false | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (true) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (true) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (true) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (true) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (true) | DocumentRetentionPolicyInd |
| Compensation Process CEO | Yes (true) | CompensationProcessCEOInd |
| Compensation Process Other | Yes (true) | CompensationProcessOtherInd |
| Investment In Joint Venture | false | InvestmentInJointVentureInd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | JOSHUA CHRISTENSEN CFO | PersonNm |
| Phone | 6057242159 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 708 8TH STREET | AddressLine1 |
| City | ARMOUR | City |
| State | SD | State |
| ZIP Code | 57313 | ZIPCode |
Form990 Part VII Section A Form990PartVIISectionAGrp (14 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Highest Compensated EmployeeHighestCompensatedEmployeeInd |
|---|---|---|---|---|---|---|---|
| MERNA BYE | |||||||
| PRESIDENT | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| JOEL BAIER | |||||||
| VICE-PRESIDE | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| JODI SCHRANK | |||||||
| SECRETARY | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| DON VAN DER WERFF | |||||||
| TREASURER | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| STANLEY BULT | |||||||
| DIRECTOR | Yes (X) | $0 | $0 | $0 | |||
| BEVERLY JONES | |||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| BRAD VANDEN BERG | |||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| HEATH BROUWER | |||||||
| ADMINISTRATO | 40.00 | Yes (X) | $118,300 | $0 | $15,056 | ||
| JOSHUA CHRISTENSEN | |||||||
| CHIEF FINANC | 40.00 | Yes (X) | $69,014 | $0 | $7,945 | ||
| MORGAN MERRILL | |||||||
| PHYSICIAN | 40.00 | $219,269 | $0 | $28,155 | Yes (X) | ||
| MARLYS LUEBKE | |||||||
| PHYSICIAN | 40.00 | $172,272 | $0 | $25,223 | Yes (X) | ||
| VANESSA MIILLER | |||||||
| PHYSICIAN AS | 40.00 | $127,520 | $0 | $16,661 | Yes (X) | ||
| JENNIFER BIETZ | |||||||
| PHYSICIAN AS | 40.00 | $112,846 | $0 | $22,921 | Yes (X) | ||
| KRISTIN BITTNER | |||||||
| PHARMACIST | 40.00 | $104,466 | $0 | $10,608 | Yes (X) | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $923,687 | TotalReportableCompFromOrgAmt |
| Total Other Compensation | $126,569 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 7 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | false | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (true) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | false | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (5 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1 | CityContractorAddress/USAddress/City | StateContractorAddress/USAddress/State | ZIP CodeContractorAddress/USAddress/ZIPCode | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| SCOTT DOOM CONTRACTING INC | |||||
| 39370 MOON MEADO DRIVE | WAGNER | SD | 57380 | CONSTRUCTION | $2,936,298 |
| SANFORD HEALTH | |||||
| PO BOX 5039 | SIOUX FALLS | SD | 57117 | MEDICAL SERVICE | $344,898 |
| ZOSS ANESTHESIA PC | |||||
| 42668 263RD ST | EMERY | SD | 57332 | MEDICAL SERVICE | $229,383 |
| MEDICAL SERVICE SOLUTIONS | |||||
| 3223 32ND AVE A STE 201 | FARGO | ND | 58104 | EQUIPMENT REPAI | $120,677 |
| SANFORD LABORATORIES | |||||
| PO BOX 5056 | SIOUX FALLS | SD | 57117 | MEDICAL SERVICE | $104,529 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 5 | CntrctRcvdGreaterThan100KCnt |
| Government Grants | $27,151 | GovernmentGrantsAmt |
| All Other Contributions | $13,920 | AllOtherContributionsAmt |
| Total Contributions | $41,071 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | PROGRAM SERVICE REVENUE | Desc |
| Total Revenue Column | $8,521,144 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $8,521,144 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $8,521,144 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $3,989 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $3,989 | RelatedOrExemptFuncIncomeAmt |
Other Revenue Misc OtherRevenueMiscGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | OTHER REVENUE | Desc |
| Total Revenue Column | $186,974 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $186,974 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $186,974 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $8,753,178 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $8,712,107 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part IX | Yes (X) | InfoInScheduleOPartIXInd |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $205,638 | TotalAmt |
| Management And General | $205,638 | ManagementAndGeneralAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,458,071 | TotalAmt |
| Program Services | $3,172,869 | ProgramServicesAmt |
| Management And General | $285,202 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $162,048 | TotalAmt |
| Program Services | $141,993 | ProgramServicesAmt |
| Management And General | $20,055 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $387,299 | TotalAmt |
| Program Services | $341,770 | ProgramServicesAmt |
| Management And General | $45,529 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $250,064 | TotalAmt |
| Program Services | $217,518 | ProgramServicesAmt |
| Management And General | $32,546 | ManagementAndGeneralAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,272 | TotalAmt |
| Management And General | $3,272 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $82,602 | TotalAmt |
| Management And General | $82,602 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $938,963 | TotalAmt |
| Program Services | $820,705 | ProgramServicesAmt |
| Management And General | $118,258 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $65,948 | TotalAmt |
| Program Services | $9,762 | ProgramServicesAmt |
| Management And General | $56,186 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $144,484 | TotalAmt |
| Program Services | $141,561 | ProgramServicesAmt |
| Management And General | $2,923 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $21,104 | TotalAmt |
| Program Services | $20,309 | ProgramServicesAmt |
| Management And General | $795 | ManagementAndGeneralAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $16,429 | TotalAmt |
| Program Services | $16,429 | ProgramServicesAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $363,660 | TotalAmt |
| Program Services | $363,660 | ProgramServicesAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $106,518 | TotalAmt |
| Program Services | $35,474 | ProgramServicesAmt |
| Management And General | $71,044 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| SUPPLIES | $2,124,833 | $2,056,769 | $68,064 |
| REPAIRS AND MAINTENANCE | $176,411 | $176,411 | |
| OTHER TAXES | $53,407 | $36,000 | $17,407 |
| RENT AND LEASES | $46,790 | $46,790 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | -$25,337 | TotalAmt |
| Program Services | -$30,921 | ProgramServicesAmt |
| Management And General | $5,584 | ManagementAndGeneralAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $8,582,204 | TotalAmt |
| Program Services | $7,567,099 | ProgramServicesAmt |
| Management And General | $1,015,105 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $500 | BOYAmt |
| EOY | $500 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,817,188 | BOYAmt |
| EOY | $1,832,530 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $834,021 | BOYAmt |
| EOY | $1,324,173 | EOYAmt |
Rcvbl From Disqualified Prsn RcvblFromDisqualifiedPrsnGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $15,775 | BOYAmt |
| EOY | $2,640 | EOYAmt |
Oth Notes Loans Receivable Net OthNotesLoansReceivableNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $9,926 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $401,228 | BOYAmt |
| EOY | $430,942 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $39,940 | BOYAmt |
| EOY | $37,835 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $10,866,046 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $3,359,057 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,993,827 | BOYAmt |
| EOY | $7,506,989 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,359,939 | BOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $8,462,418 | BOYAmt |
| EOY | $11,145,535 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $463,569 | BOYAmt |
| EOY | $1,047,446 | EOYAmt |
Deferred Revenue DeferredRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $11,952 | BOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,782,846 | BOYAmt |
| EOY | $3,703,036 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,875 | BOYAmt |
| EOY | $23,903 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,262,242 | BOYAmt |
| EOY | $4,774,385 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Org Does Not Follow SFAS117 | Yes (X) | OrgDoesNotFollowSFAS117Ind |
Rtn Earn Endowment Incm Oth Fnds RtnEarnEndowmentIncmOthFndsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $6,200,176 | BOYAmt |
| EOY | $6,371,150 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $6,200,176 | BOYAmt |
| EOY | $6,371,150 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $8,462,418 | BOYAmt |
| EOY | $11,145,535 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | $170,974 | ReconcilationRevenueExpnssAmt |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | false | AccountantCompileOrReviewInd |
| FS Audited | Yes (true) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Separate Basis Fincl Stmt | Yes (X) | SeparateBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | Yes (true) | AuditCommitteeInd |
| Federal Grant Audit Required | Yes (true) | FederalGrantAuditRequiredInd |
| Federal Grant Audit Performed | Yes (true) | FederalGrantAuditPerformedInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital | Yes (X) | HospitalInd |
Schedule D IRS990ScheduleD
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $170,779 | OtherCostOrOtherBasisAmt |
| Book Value | $170,779 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $7,860,211 | OtherCostOrOtherBasisAmt |
| Depreciation | $1,054,067 | DepreciationAmt |
| Book Value | $6,806,144 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $2,835,056 | OtherCostOrOtherBasisAmt |
| Depreciation | $2,304,990 | DepreciationAmt |
| Book Value | $530,066 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $7,506,989 | TotalBookValueLandBuildingsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp (2 entries)
| DescDesc | AmtAmt |
|---|---|
| DUE TO THIRD PARTIES | $19,278 |
| DEPOSITS - PRAIRIE VILLA | $4,625 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $23,903 | TotalLiabilityAmt |
| Total Rev Etc Audited Fincl Stmt | $8,422,698 | TotalRevEtcAuditedFinclStmtAmt |
| Revenue Subtotal | $8,422,698 | RevenueSubtotalAmt |
| Other Revenues Not Included | $330,480 | OtherRevenuesNotIncludedAmt |
| Revenue Not Reported Fincl Stmt | $330,480 | RevenueNotReportedFinclStmtAmt |
| Total Revenue Per Form990 | $8,753,178 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $8,251,724 | TotExpnsEtcAuditedFinclStmtAmt |
| Expenses Subtotal | $8,251,724 | ExpensesSubtotalAmt |
| Other Expenses Not Included | $330,480 | OtherExpensesNotIncludedAmt |
| Expenses Not Rpt Fincl Stmt | $330,480 | ExpensesNotRptFinclStmtAmt |
| Total Expenses Per Form990 | $8,582,204 | TotalExpensesPerForm990Amt |
Supplemental Information Detail SupplementalInformationDetail (2 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| SCHEDULE D, PAGE 4, PART XI, LINE 4B | ASSISTED LIVING REVENUES - NETTED ON FINANCIAL STATEMENTS 330,480 |
| SCHEDULE D, PAGE 4, PART XII, LINE 4B | ASSISTED LIVING EXPENSES - NETTED ON FINANCIAL STATEMENTS 330,480 |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Assistance Policy | Yes (true) | FinancialAssistancePolicyInd |
| Written Policy | Yes (true) | WrittenPolicyInd |
| FPG Reference Free Care | Yes (true) | FPGReferenceFreeCareInd |
Free Care Oth Percentage FreeCareOthPercentageGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | Yes (X) | OtherInd |
| Free Care Other | 1.250000000000 | FreeCareOtherPct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| FPG Reference Discounted Care | Yes (true) | FPGReferenceDiscountedCareInd |
| Percent200 D | Yes (X) | Percent200DInd |
| Free Care Medically Indigent | Yes (true) | FreeCareMedicallyIndigentInd |
| Financial Assistance Budget | Yes (true) | FinancialAssistanceBudgetInd |
| Expenses Exceed Budget | Yes (true) | ExpensesExceedBudgetInd |
| Unable To Provide Care | false | UnableToProvideCareInd |
| Annual Community Bnft Report | false | AnnualCommunityBnftReportInd |
Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $42,934 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $42,934 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00500 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $42,934 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $42,934 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00500 | TotalExpensePct |
Community Health Services CommunityHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $200,490 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $96,714 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $103,776 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.01210 | TotalExpensePct |
Total Other Benefits TotalOtherBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $200,490 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $96,714 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $103,776 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.01210 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $243,424 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $96,714 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $146,710 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.01710 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | Yes (true) | BadDebtExpenseReportedInd |
| Bad Debt Expense | $186,568 | BadDebtExpenseAmt |
| Bad Debt Expense Attributable | $46,642 | BadDebtExpenseAttributableAmt |
| Reimbursed By Medicare | $4,659,333 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $6,037,123 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | -$1,377,790 | MedicareSurplusOrShortfallAmt |
Costing Methodology Used CostingMethodologyUsedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | Yes (X) | OtherInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | false | WrittenDebtCollectionPolicyInd |
| Hospital Facilities | 1 | HospitalFacilitiesCnt |
Hospital Facilities HospitalFacilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | DOUGLAS COUNTY MEMORIAL HOSPITAL | BusinessNameLine1 |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 708 8TH STREET | AddressLine1 |
| City | ARMOUR | City |
| State | SD | State |
| ZIP Code | 57313 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Website Address | WWW.DCMHSD.ORG | WebsiteAddressTxt |
| State License | LICENSE 10526 | StateLicenseNum |
| Critical Access Hospital | Yes (X) | CriticalAccessHospitalInd |
Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | DOUGLAS COUNTY MEMORIAL HOSPITAL | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
| CHNA Conducted | Yes (true) | CHNAConductedInd |
| Community Definition | Yes (X) | CommunityDefinitionInd |
| Community Demographics | Yes (X) | CommunityDemographicsInd |
| Existing Resources | Yes (X) | ExistingResourcesInd |
| How Data Obtained | Yes (X) | HowDataObtainedInd |
| Community Health Needs | Yes (X) | CommunityHealthNeedsInd |
| Other Health Issues | Yes (X) | OtherHealthIssuesInd |
| Community Hlth Needs Id Process | Yes (X) | CommunityHlthNeedsIdProcessInd |
| Consulting Process | Yes (X) | ConsultingProcessInd |
| Information Gaps | Yes (X) | InformationGapsInd |
| Other | Yes (X) | OtherInd |
| CHNA Conducted | 12 | CHNAConductedYr |
| Take Into Account Others Input | Yes (true) | TakeIntoAccountOthersInputInd |
| CHNA Conducted With Other Fclts | false | CHNAConductedWithOtherFcltsInd |
| CHNA Report Widely Available | Yes (true) | CHNAReportWidelyAvailableInd |
| Rpt Available On Own Website | Yes (X) | RptAvailableOnOwnWebsiteInd |
| Own Website URL | WWW.DCMHSD.ORG | OwnWebsiteURLTxt |
| Rpt Available Upon Request | Yes (X) | RptAvailableUponRequestInd |
| Prioritize Health Needs | Yes (X) | PrioritizeHealthNeedsInd |
| Prioritize Services | Yes (X) | PrioritizeServicesInd |
| All Needs Addressed | Yes (true) | AllNeedsAddressedInd |
| Organization Incur Excise Tax | false | OrganizationIncurExciseTaxInd |
| Elig Criteria Explained | Yes (true) | EligCriteriaExplainedInd |
| FPG Used Deter Elig Free Care | Yes (true) | FPGUsedDeterEligFreeCareInd |
| FPG Family Incm Lmt Free Care | 125.000000000000 | FPGFamilyIncmLmtFreeCarePct |
| FPG Used Determ Elig Dscnt Care | Yes (true) | FPGUsedDetermEligDscntCareInd |
| FPG Family Incm Lmt Dscnt Care | 200.000000000000 | FPGFamilyIncmLmtDscntCarePct |
| Explained Basis | Yes (true) | ExplainedBasisInd |
| Income Level | Yes (X) | IncomeLevelInd |
| Asset Level | Yes (X) | AssetLevelInd |
| Medical Indigency | Yes (X) | MedicalIndigencyInd |
| Insurance Status | Yes (X) | InsuranceStatusInd |
| Uninsured Discount | Yes (X) | UninsuredDiscountInd |
| Medicaid Medicare | Yes (X) | MedicaidMedicareInd |
| State Regulation | Yes (X) | StateRegulationInd |
| App Financial Asst Expln | Yes (true) | AppFinancialAsstExplnInd |
| Includes Publicity Measures | Yes (true) | IncludesPublicityMeasuresInd |
| Attached To Invoice | Yes (X) | AttachedToInvoiceInd |
| Available On Request | Yes (X) | AvailableOnRequestInd |
| FAP Actions On Nonpayment | Yes (true) | FAPActionsOnNonpaymentInd |
| Permit Other Actions | Yes (X) | PermitOtherActionsInd |
| Collection Activities | Yes (true) | CollectionActivitiesInd |
| Reporting To Credit Agency | Yes (X) | ReportingToCreditAgencyInd |
| Lawsuit | Yes (X) | LawsuitInd |
| Liens On Residences | Yes (X) | LiensOnResidencesInd |
| FAP Notified All Patients | Yes (X) | FAPNotifiedAllPatientsInd |
| Documented Elig Determination | Yes (X) | DocumentedEligDeterminationInd |
| Nondis Emergency Care Policy | Yes (true) | NondisEmergencyCarePolicyInd |
| Other Method Used | Yes (X) | OtherMethodUsedInd |
| Amounts Generally Billed | false | AmountsGenerallyBilledInd |
| Gross Charges | false | GrossChargesInd |
Supplemental Information SupplementalInformationGrp (3 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FACILITY 1, DOUGLAS COUNTY MEMORIAL HOSPITAL - PART V, LINE 3 | IN CONDUCTING THE CHNA THE HOSPITAL FACILITY RELIED HEAVILY UPON THE KNOWLEDGE OF THE LOAL HOME HEALTH PROVIDERS, DOUGLAS COUNTY COMMUNITY HEALTH NURSE, REGIONAL MANAGER OF THE COMMUNITY HEALTH PROGRAMS SERVING BOTH DOUGLAS AND CHARLES MIX COUNTIES, AND THE HOSPITAL'S DIRECTOR OF NURSING. THE HOSPITAL RELIED ON THEIR INPUT AS TO WHAT THE NEEDS OF THE COMMUNITY ARE BASED ON THEIR WORKING KNOWLEDGE OF THE ILLNESSES THAT ARE OCCURRING IN THE TWO COUNTIES. |
| FACILITY 1, DOUGLAS COUNTY MEMORIAL HOSPITAL - PART V, LINE 16E | THE HOSPITAL FACILITY'S COLLECTION ACTIONS CONSIST OF BILLING STATEMENTS ALONG WITH FOLLOW UP PHONE CALLS IF THERE IS NO RESPONSE THROUGH OUR BILLING ATTEMPTS. ALL OTHER COLLECTIONS ARE SENT TO A THIRD-PARTY COLLECTION AGENCY FOR FURTHER COLLECTION ATTEMPTS. |
| FACILITY 1, DOUGLAS COUNTY MEMORIAL HOSPITAL - PART V, LINE 20D | ALL PATIENTS ARE CHARGED THE SAME GROSS CHARGE AMOUNTS FOR ALL SERVICES. FROM THIS POINT, ADJUSTMENTS ARE MADE FOR INSURANCE, PRIVATE PAY, MEDICARE OR MEDICAID BASED ON THE INDIVIDUAL'S METHOD OF COVERAGE. AFTER ADJUSTMENTS, FINANCIAL ASSISTANCE NEEDS ARE MEASURED AND CHARGES ARE ADJUSTED ACCORDINGLY BASED ON THE NEEDS AND FINANCIAL SITUATION OF THE INDIVIDUALS. |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 7 | FacilityNum |
Oth Hlth Care Fclts Not Hospital OthHlthCareFcltsNotHospitalGrp
Oth Hlth Care Fclts OthHlthCareFcltsGrp (7 entries)
| Address Line1USAddress/AddressLine1 | CityUSAddress/City | StateUSAddress/State | ZIP CodeUSAddress/ZIPCode | FacilityFacilityTxt |
|---|---|---|---|---|
| PRAIRIE PHARMACY-CORSICA | ||||
| 230 E MAIN STREET | CORSICA | SD | 57328 | RETAIL/OUTPATIENT PHARMACY |
| PRAIRIE HEALTH CLINIC-ARMOUR | ||||
| 708 8TH STREET | ARMOUR | SD | 57313 | RURAL HEALTH CLINIC |
| PRAIRIE PHARMACY-ARMOUR | ||||
| 1311 BRADDOCK STREET | ARMOUR | SD | 57313 | RETAIL/OUTPATIENT PHARMACY |
| PRAIRIE VILLA | ||||
| 1309 BRADDOCK STREET | ARMOUR | SD | 57313 | ASSISTED LIVING CENTER |
| PRAIRIE HEALTH CLINIC-CORSICA | ||||
| 230 E MAIN STREET | CORSICA | SD | 57328 | RURAL HEALTH CLINIC |
| PRAIRIE HEALTH CLINIC-WAGNER | ||||
| 310 W SD HWY 46 | WAGNER | SD | 57380 | RURAL HEALTH CLINIC |
| PRAIRIE HEALTH CLINIC-STICKNEY | ||||
| 301 MAIN STREET | STICKNEY | SD | 57375 | RURAL HEALTH CLINIC |
Supplemental Information Detail SupplementalInformationDetail (7 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART I, LINE 7 - COSTING METHODOLOGY EXPLANATION | THE COSTING METHODOLOGY USED FOR LINE 7 IS THE FACILITY'S MEDICARE COST REPORT. |
| PART III, LINE 2 - BAD DEBT EXPENSE METHODOLOGY | BAD DEBTS WERE BASED 75% OF HOSPITAL'S AUDITED FINANCIAL STATEMENTS FIGURE. THE 75% CAME FROM THE CALCULATION FIGURED ON WORKSHEET 2 OF THE SCHEDULE H INSTRUCTIONS PART III, LINE 3 - BASED ON A SAMPLE OF ACCOUNTS WRITTEN OFF TO COLLECTION AGENCIES THAT WERE NOT INCLUDED IN THE COMMUNITY BENEFIT. PART III, LINE 4 - ALLOWANCE FOR DOUBTFUL ACCOUNTS WHICH EXCLUDES CHARITY CARE AND DISCOUNTS. THIS AMOUNT IS CONSIDERED TO BE UNCOLLECTIBLE. THE AUDITED FINANCIAL STATEMENT INCLUDES THE FOLLOWING STATEMENT ON PATIENT RECEIVABLES: "PATIENT RECEIVABLES ARE SHOWN AT THE NET AMOUNT EXPECTED TO BE COLLECTED AFTER DUE ALLOWANCES FOR UNCOLLECTIBLE ACCOUNTS, BASED ON AGING OF ALL THE INDIVIDUAL PATIENT BALANCES, AND CONTRACTUAL ALLOWANCE FOR THIRD-PARTY PAYORS. THE PROVISION OF UNCOLLECTIBLES AT MAY 31, 2014 AND 2013 WAS 299,000 AND 221,000 RESPECTIVELY." PART III, LINE 6 - FIGURE IS TAKEN DIRECTLY FROM THE MEDICARE COST REPORT FILED FOR FY14. |
| PART III, LINE 8 - MEDICARE EXPLANATION | THIS SHORTFALL SHOULD BE TREATED AS COMMUNITY BENEFIT SINCE IF THESE SERVICES WERE NOT PROVIDED, IT WOULD BE A UNDUE BURDEN TO THE COMMUNITY TO TRAVEL TO ANOTHER FACILITY TO RECEIVE SERVICES. |
| PART VI, LINE 2 - NEEDS ASSESSMENT | THE DOUGLAS COUNTY MEMORIAL HOSPITAL IS RESPONSIVE TO THE NEEDS OF THE PATIENTS IT SERVES. THE FACILITY IS CONTINUALLY EVALUATING THE SERVICES IT PROVIDES, IN TALKS WITH LOCAL AGENCIES ABOUT THE SERVICES PROVIDED, AND IS ALWAYS OPEN TO INPUT FROM THE COMMUNITY ON EXPANDING OR ADDING SERVICES. OFTEN SERVICES CANNOT BE PROVIDED DIRECTLY BY THE HOSPITAL ITSELF, HOWEVER ARRANGEMENTS ARE MADE IN OR TO BRING OUTSIDE PROVIDERS AND/OR EQUIPMENT IN ORDER TO ALLOW THE COMMUNITY THE ABILITY TO RECEIVE THE CARE LOCALLY. |
| PART VI, LINE 3 - PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE | PATIENT FINANCIAL SERVICES EVALUATES EACH ACCOUNT FOR PATIENT ELIGIBILITY UNDER FEDERAL, STATE, OR LOCAL GOVERNMENT PROGRAMS AND PROVIDES ELGIBILE PATIENTS WITH INFORMATION REGARDING THESE PROGRAMS ALONG WITH THE ORGANIZATION'S FINANCIAL ASSISTANCE POLICY. THE HOSPITAL DOES NOT PURSUE COLLECTION OF AMOUNTS DETERMINED TO BE WRITTEN OFF THROUGH FINANCIAL ASSISTANCE. |
| PART VI, LINE 4 - COMMUNITY INFORMATION | DOUGLAS COUNTY MEMORIAL HOSPITAL PROVIDES HEALTHCARE SERVICES TO PERSONS IN THE ARMOUR, CORSICA, STICKNEY, AND WAGNER COMMUNITIES. DURING THE FISCAL YEAR ENDED MAY 31, 2014, THE HOSPITAL PROVIDED 844 INPATIENT DAYS, 557 EMERGENCY ROOM VISITS, 9,412 OUTPATIENT VISITS AND 5,561 ASSISTED LIVING (PRAIRIE VILLA) DAYS. THE FACILITY PROVIDED 1,411 HOME DELIVERED MEALS TO HOME-BOUND COMMUNITY MEMBERS ALONG WITH 2,796 MEALS TO SENIOR MEALS PROGRAM. EACH RURAL HEALTH CLINIC LOCATION CONDUCTS AN ANNUAL HEALTH FAIR. FOR THE FISCAL YEAR ENDED MAY 31, 2014, THE HOSPITAL PROVIDED 125 PSA AND 303 LIPID LAB TESTS AT NO CHARGE. |
| PART VI, LINE 5 - PROMOTION OF COMMUNITY HEALTH | THE BOARD OF DIRECTORS IS COMPLETELY MADE UP OF COMMUNITY MEMBERS WHO RESIDE IN THE ORGANIZATION'S PRIMARY SERVICE AREA WHO ARE NEITHER EMPLOYED BY NOR INDEPENDENT CONTRACTORS OF THE ORGANIZATION. THE HOSPITAL ALSO PROVIDES THE PHYSICAL LOCATION FOR THE DOUGLAS COUNTY COMMUNITY HEALTH OFFICE WHICH ALSO ALLOWS THE HOSPITAL TO WORK CLOSELY WITH OUR LOCAL HEALTH AGENCY. |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Employment Contract | Yes (X) | WrittenEmploymentContractInd |
| Compensation Survey | Yes (X) | CompensationSurveyInd |
| Board Or Committee Approval | Yes (X) | BoardOrCommitteeApprovalInd |
| Severance Payment | false | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | false | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | false | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | false | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | false | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | false | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | false | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | false | AnyNonFixedPaymentsInd |
| Initial Contract Exception | false | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (2 entries)
| TitleTitleTxt | Base Compensation Filing OrgBaseCompensationFilingOrgAmt | Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt | Total Compensation Filing OrgTotalCompensationFilingOrgAmt |
|---|---|---|---|
| MORGAN MERRILL | |||
| PHYSICIAN | $219,269 | $28,155 | $247,424 |
| MARLYS LUEBKE | |||
| PHYSICIAN | $172,272 | $25,223 | $197,495 |
Schedule L IRS990ScheduleL
Loans Btwn Org Interested Prsn LoansBtwnOrgInterestedPrsnGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | MORGAN MERRILL | PersonNm |
| Relationship With Org | EMPLOYEE | RelationshipWithOrgTxt |
| Loan Purpose | TRAVEL ADVANCE | LoanPurposeTxt |
| Loan From Organization | Yes (X) | LoanFromOrganizationInd |
| Original Principal | $28,500 | OriginalPrincipalAmt |
| Balance Due | $2,640 | BalanceDueAmt |
| Default | false | DefaultInd |
| Board Or Committee Approval | Yes (true) | BoardOrCommitteeApprovalInd |
| Written Agreement | Yes (true) | WrittenAgreementInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Balance Due | $2,640 | TotalBalanceDueAmt |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (7 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PAGE 6, PART VI, LINE 11B | THE 990 IS REVIEWED AND APPROVED BY THE ADMINISTRATOR AND CHIEF FINANCIAL OFFICER BEFORE FILING. |
| FORM 990, PAGE 6, PART VI, LINE 12C | AT THE BOARD'S ANNUAL MEETING |
| FORM 990, PAGE 6, PART VI, LINE 15A | PROCESS COMPLETED THROUGH BOARD COMPENSATION COMMITTEE |
| FORM 990, PAGE 6, PART VI, LINE 15B | PROCESS COMPLETED THROUGH BOARD COMPENSATION COMMITTEE |
| FORM 990, PAGE 6, PART VI, LINE 19 | GOVERNING DOCUMENTS, POLICIES, AND FINANCIAL STATMENTES ARE AVAILABLE TO THE PUBLIC UPON REQUEST. |
| FORM 990, PART IX, LINE 11G | 820,705 118,258 0 |
| FORM 990, PART XI, LINE 9 | ASSISTED LIVING REVENUES - NETTED ON FINANCIAL STATEMENTS -330,480 ASSISTED LIVING EXPENSES - NETTED ON FINANCIAL STATEMENTS 330,480 |
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