2015-01-15T12:12:19-06:00 2014-05-31 460434947 ELO PROF LLC PO BOX 249 MITCHELL SD 57301 990 2013-06-01 460400557 DOUGLAS COUNTY MEMORIAL HOSPITAL DOUG 6057242159 708 8TH STREET ARMOUR SD 573132102 HEATH BROUWER ADMINISTRATOR 6057242159 2015-01-13 true JAY TOLSMA CPA P00736087 6059967717 2015-01-14 2013 2016-02-25 16:41:14Z HEATH BROUWER 708 8TH ST ARMOUR SD 57313 8753178 false X WWW.DCMHSD.ORG X PROMOTION OF GENERAL HEALTH CARE AND REHABILITATION SERVICES 7 7 108 0 580760 41071 7754004 8521144 4469 3989 185660 186974 8524893 8753178 0 0 4152660 4463120 0 0 3781450 4119084 7934110 8582204 590783 170974 8462418 11145535 2262242 4774385 6200176 6371150 PROMOTION OF GENERAL HEALTH CARE AND REHABILITATION SERVICES false false 7567099 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. 7567099 true false false false false false false false false false true false false false true false true false false false false false false false false false true true false false true false false false true false false false false false false false false false false false false false true 22 0 true 108 true false false false false false false false false false false false false X 7 7 false false false false false false false true true false false false true true true true true true true false X JOSHUA CHRISTENSEN CFO 6057242159 708 8TH STREET ARMOUR SD 57313 MERNA BYE PRESIDENT 1.00 X X 0 0 0 JOEL BAIER VICE-PRESIDE 1.00 X X 0 0 0 JODI SCHRANK SECRETARY 1.00 X X 0 0 0 DON VAN DER WERFF TREASURER 1.00 X X 0 0 0 STANLEY BULT DIRECTOR X 0 0 0 BEVERLY JONES DIRECTOR 1.00 X 0 0 0 BRAD VANDEN BERG DIRECTOR 1.00 X 0 0 0 HEATH BROUWER ADMINISTRATO 40.00 X 118300 0 15056 JOSHUA CHRISTENSEN CHIEF FINANC 40.00 X 69014 0 7945 MORGAN MERRILL PHYSICIAN 40.00 X 219269 0 28155 MARLYS LUEBKE PHYSICIAN 40.00 X 172272 0 25223 VANESSA MIILLER PHYSICIAN AS 40.00 X 127520 0 16661 JENNIFER BIETZ PHYSICIAN AS 40.00 X 112846 0 22921 KRISTIN BITTNER PHARMACIST 40.00 X 104466 0 10608 923687 126569 7 false true false SCOTT DOOM CONTRACTING INC 39370 MOON MEADO DRIVE WAGNER SD 57380 CONSTRUCTION 2936298 SANFORD HEALTH PO BOX 5039 SIOUX FALLS SD 57117 MEDICAL SERVICE 344898 ZOSS ANESTHESIA PC 42668 263RD ST EMERY SD 57332 MEDICAL SERVICE 229383 MEDICAL SERVICE SOLUTIONS 3223 32ND AVE A STE 201 FARGO ND 58104 EQUIPMENT REPAI 120677 SANFORD LABORATORIES PO BOX 5056 SIOUX FALLS SD 57117 MEDICAL SERVICE 104529 5 27151 13920 41071 PROGRAM SERVICE REVENUE 8521144 8521144 8521144 3989 3989 OTHER REVENUE 186974 186974 186974 8753178 8712107 X 205638 205638 3458071 3172869 285202 162048 141993 20055 387299 341770 45529 250064 217518 32546 3272 3272 82602 82602 938963 820705 118258 65948 9762 56186 144484 141561 2923 21104 20309 795 16429 16429 363660 363660 106518 35474 71044 SUPPLIES 2124833 2056769 68064 REPAIRS AND MAINTENANCE 176411 176411 OTHER TAXES 53407 36000 17407 RENT AND LEASES 46790 46790 -25337 -30921 5584 8582204 7567099 1015105 0 500 500 1817188 1832530 834021 1324173 15775 2640 9926 401228 430942 39940 37835 10866046 3359057 2993827 7506989 2359939 8462418 11145535 463569 1047446 11952 1782846 3703036 3875 23903 2262242 4774385 X 6200176 6371150 6200176 6371150 8462418 11145535 170974 X false true X true true true X 170779 170779 7860211 1054067 6806144 2835056 2304990 530066 7506989 DUE TO THIRD PARTIES 19278 DEPOSITS - PRAIRIE VILLA 4625 23903 8422698 8422698 330480 330480 8753178 8251724 8251724 330480 330480 8582204 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 true true true X 1.250000000000 true X true true true false false 42934 42934 0.00500 42934 42934 0.00500 200490 96714 103776 0.01210 200490 96714 103776 0.01210 243424 96714 146710 0.01710 true 186568 46642 4659333 6037123 -1377790 X false 1 1 DOUGLAS COUNTY MEMORIAL HOSPITAL 708 8TH STREET ARMOUR SD 57313 WWW.DCMHSD.ORG LICENSE 10526 X DOUGLAS COUNTY MEMORIAL HOSPITAL 1 true X X X X X X X X X X 12 true false true X WWW.DCMHSD.ORG X X X true false true true 125.000000000000 true 200.000000000000 true X X X X X X X true true X X true X true X X X X X true X false false 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. 7 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 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. X X X false false false false false false false false false MORGAN MERRILL PHYSICIAN 219269 28155 247424 MARLYS LUEBKE PHYSICIAN 172272 25223 197495 MORGAN MERRILL EMPLOYEE TRAVEL ADVANCE X 28500 2640 false true true 2640 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