MOBRIDGE REGIONAL HOSPITAL: Form 990, tax year 2012
View the entire original 990 at ProPublica ↗
- Organization
- MOBRIDGE REGIONAL HOSPITAL (EIN 46-0255944)
- Tax period
- 2012-10-01 to 2013-09-30
- Filed
- 2014-08-14
- IRS object ID
- 201402269349304350
- Schema version
- 2012v2.1
- 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) |
|---|---|---|
| Timestamp | 2014-08-14T16:04:39-05:00 | Timestamp |
| Tax Period End Date | 2013-09-30 | TaxPeriodEndDate |
Preparer Firm PreparerFirm
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 450250958 | EIN |
Preparer Firm Business Name PreparerFirmBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | EIDE BAILLY LLP | BusinessNameLine1 |
Preparer Firm US Address PreparerFirmUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 200 EAST 10TH ST PO BOX 5125 | AddressLine1 |
| City | SIOUX FALLS | City |
| State | SD | State |
| ZIP Code | 571175125 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnType |
| Tax Period Begin Date | 2012-10-01 | TaxPeriodBeginDate |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 460255944 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Mobridge Regional Hospital | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Control | MOBR | NameControl |
| Phone | 6058453692 | Phone |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1401 10th Ave W | AddressLine1 |
| City | Mobridge | City |
| State | SD | State |
| ZIP Code | 57601 | ZIPCode |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | Angelia Svihovec | Name |
| Title | CEO | Title |
| Phone | 6058453692 | Phone |
| Date Signed | 2014-08-14 | DateSigned |
| Authorize Third Party | 1 | AuthorizeThirdParty |
Preparer Preparer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | Laurie Hanson | Name |
| PTIN | P00851848 | PTIN |
| Phone | 6053391999 | Phone |
| Date Prepared | 2014-08-14 | DatePrepared |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax Year | 2012 | TaxYear |
| Build TS | 2015-11-30 17:44:51Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Principal Officer Person | Angelia Svihovec | NameOfPrincipalOfficerPerson |
Address Principal Officer US AddressPrincipalOfficerUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1401 10th Ave W | AddressLine1 |
| City | Mobridge | City |
| State | SD | State |
| ZIP Code | 57601 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | 19286102 | GrossReceipts |
| Group Return For Affiliates | 0 | GroupReturnForAffiliates |
| Organization501c3 | X | Organization501c3 |
| Web Site | www.mobridgehospital.org | WebSite |
| Type Of Organization Corporation | X | TypeOfOrganizationCorporation |
| Year Formation | 1959 | YearFormation |
| State Legal Domicile | SD | StateLegalDomicile |
| Activity Or Mission Description | Providing healthcare to people throughout the region. | ActivityOrMissionDescription |
| Nbr Voting Members Governing Body | 12 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 10 | NbrIndependentVotingMembers |
| Total Nbr Employees | 183 | TotalNbrEmployees |
| Total Nbr Volunteers | 200 | TotalNbrVolunteers |
| Total Gross UBI | 0 | TotalGrossUBI |
| Net Unrelated Business Txbl Income | 0 | NetUnrelatedBusinessTxblIncome |
| Contributions Grants Prior Year | 919867 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 1406967 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 15865149 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 16222019 | ProgramServiceRevenueCY |
| Investment Income Prior Year | 48647 | InvestmentIncomePriorYear |
| Investment Income Current Year | 51632 | InvestmentIncomeCurrentYear |
| Other Revenue Prior Year | 88669 | OtherRevenuePriorYear |
| Other Revenue Current Year | 79290 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 16922332 | TotalRevenuePriorYear |
| Total Revenue Current Year | 17759908 | TotalRevenueCurrentYear |
| Grants And Similar Amnts Prior Year | 0 | GrantsAndSimilarAmntsPriorYear |
| Grants And Similar Amnts CY | 0 | GrantsAndSimilarAmntsCY |
| Benefits Paid To Members Prior Year | 0 | BenefitsPaidToMembersPriorYear |
| Benefits Paid To Members CY | 0 | BenefitsPaidToMembersCY |
| Salaries Etc Prior Year | 8818289 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 9396702 | SalariesEtcCurrentYear |
| Total Prof Fundrsng Exp Prior Year | 0 | TotalProfFundrsngExpPriorYear |
| Total Prof Fundrsng Exp CY | 0 | TotalProfFundrsngExpCY |
| Total Fundrsng Exp Current Year | 0 | TotalFundrsngExpCurrentYear |
| Other Expense Prior Year | 6862465 | OtherExpensePriorYear |
| Other Expenses Current Year | 7417830 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 15680754 | TotalExpensesPriorYear |
| Total Expenses Current Year | 16814532 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | 1241578 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | 945376 | RevenuesLessExpensesCY |
| Total Assets BOY | 17807982 | TotalAssetsBOY |
| Total Assets EOY | 20379024 | TotalAssetsEOY |
| Total Liabilities BOY | 6390929 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 8016595 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | 11417053 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 12362429 | NetAssetsOrFundBalancesEOY |
| Mission Description | The mission of Mobridge Regional Hospital is to provide high quality healthcare services in a compassionate and professional manner for people throughout the region. | MissionDescription |
| Significant New Program Services | 0 | SignificantNewProgramServices |
| Significant Change | 0 | SignificantChange |
| Expense | 15030610 | Expense |
| Revenue | 16222019 | Revenue |
| Description | Mobridge Regional Hospital (MRH) provides healthcare services to persons throughout the region. During the fiscal year ended September 30, 2013, the hospital had: 1,949 Patient Days 1,621 Acute Care Days21,983 Outpatient Visits 5,407 Assisted Living Days (Prairie Sunset Village) | Description |
| Total Program Service Expense | 15030610 | TotalProgramServiceExpense |
| Described In501 C3 | 1 | DescribedIn501C3 |
| Schedule B Required | 1 | ScheduleBRequired |
| Political Activities | 0 | PoliticalActivities |
| Lobbying Activities | 0 | LobbyingActivities |
| Subject To Proxy Tax | 0 | SubjectToProxyTax |
| Donor Advised Funds | 0 | DonorAdvisedFunds |
| Conservation Easements | 0 | ConservationEasements |
| Collections Of Art | 0 | CollectionsOfArt |
| Credit Counseling | 0 | CreditCounseling |
| Term Or Permanent Endowments | 0 | TermOrPermanentEndowments |
| Report Land Bldg Equip | 1 | ReportLandBldgEquip |
| Report Invest Oth Securities | 0 | ReportInvestOthSecurities |
| Report Prog Rel Invest | 0 | ReportProgRelInvest |
| Report Other Assets | 0 | ReportOtherAssets |
| Report Other Liabilities | 1 | ReportOtherLiabilities |
| Report Fin48 Footnote | 1 | ReportFin48Footnote |
| Independent Audit Financial Stmt | 1 | IndependentAuditFinancialStmt |
| Consolidated Audit Financial Stmt | 0 | ConsolidatedAuditFinancialStmt |
| School | 0 | School |
| Foreign Office | 0 | ForeignOffice |
| Foreign Activities | 0 | ForeignActivities |
| More Than5000 K To Organizations | 0 | MoreThan5000KToOrganizations |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividuals |
| Professional Fundraising | 0 | ProfessionalFundraising |
| Fundraising Activities | 0 | FundraisingActivities |
| Gaming | 0 | Gaming |
| Hospital | 1 | Hospital |
| Financial Stmt Attached | 1 | FinancialStmtAttached |
| Grants To Organizations | 0 | GrantsToOrganizations |
| Grants To Individuals | 0 | GrantsToIndividuals |
| Schedule J Required | 1 | ScheduleJRequired |
| Tax Exempt Bonds | 1 | TaxExemptBonds |
| Invest Tax Exempt Bonds | 0 | InvestTaxExemptBonds |
| Escrow Account | 0 | EscrowAccount |
| On Behalf Of Issuer | 0 | OnBehalfOfIssuer |
| Excess Benefit Transaction | 0 | ExcessBenefitTransaction |
| Prior Excess Benefit Transaction | 0 | PriorExcessBenefitTransaction |
| Loan To Officer Or DQP | 0 | LoanToOfficerOrDQP |
| Grant To Related Person | 0 | GrantToRelatedPerson |
| Bsnss Rltnshp With Organization | 0 | BsnssRltnshpWithOrganization |
| Bsnss Rltnshp Thru Family Member | 0 | BsnssRltnshpThruFamilyMember |
| Officer Entity With Bsnss Rltnshp | 0 | OfficerEntityWithBsnssRltnshp |
| Deductible Non Cash Contributions | 0 | DeductibleNonCashContributions |
| Deductible Contributions Of Art | 0 | DeductibleContributionsOfArt |
| Terminated | 0 | Terminated |
| Partial Liquidation | 0 | PartialLiquidation |
| Disregarded Entity | 0 | DisregardedEntity |
| Related Entity | 0 | RelatedEntity |
| Related Org Controlled Entity | 0 | RelatedOrgControlledEntity |
| Transfers To Exempt Non Chrtbl Org | 0 | TransfersToExemptNonChrtblOrg |
| Activities Conducted Partnership | 0 | ActivitiesConductedPartnership |
| Schedule O Required | 1 | ScheduleORequired |
| Number Forms Transmitted With1096 | 21 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Compliance With Backup Witholding | 1 | ComplianceWithBackupWitholding |
| Number Of Employees | 183 | NumberOfEmployees |
| Employment Tax Returns Filed | 1 | EmploymentTaxReturnsFiled |
| Unrelated Business Income | 0 | UnrelatedBusinessIncome |
| Foreign Financial Account | 0 | ForeignFinancialAccount |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTrans |
| Taxable Party Notification | 0 | TaxablePartyNotification |
| Non Deductible Contributions | 0 | NonDeductibleContributions |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributions |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOf |
| Funds To Pay Premiums | 0 | FundsToPayPremiums |
| Premiums Paid | 0 | PremiumsPaid |
| Indoor Tanning Services | 0 | IndoorTanningServices |
| Info In Schedule O Part VI | X | InfoInScheduleOPartVI |
| Nbr Voting Governing Body Members | 12 | NbrVotingGoverningBodyMembers |
| Number Independent Voting Members | 10 | NumberIndependentVotingMembers |
| Family Or Business Relationship | 0 | FamilyOrBusinessRelationship |
| Delegation Of Management Duties | 1 | DelegationOfManagementDuties |
| Changes To Organizing Docs | 0 | ChangesToOrganizingDocs |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuse |
| Members Or Stockholders | 1 | MembersOrStockholders |
| Election Of Board Members | 1 | ElectionOfBoardMembers |
| Decisions Subject To Approval | 0 | DecisionsSubjectToApproval |
| Minutes Of Governing Body | 1 | MinutesOfGoverningBody |
| Minutes Of Committees | 0 | MinutesOfCommittees |
| Officer Mailing Address | 0 | OfficerMailingAddress |
| Local Chapters | 0 | LocalChapters |
| Form990 Provided To Governing Body | 0 | Form990ProvidedToGoverningBody |
| Conflict Of Interest Policy | 1 | ConflictOfInterestPolicy |
| Annual Disclosure Covered Persons | 1 | AnnualDisclosureCoveredPersons |
| Regular Monitoring Enforcement | 1 | RegularMonitoringEnforcement |
| Whistleblower Policy | 1 | WhistleblowerPolicy |
| Document Retention Policy | 1 | DocumentRetentionPolicy |
| Compensation Process CEO | 1 | CompensationProcessCEO |
| Compensation Process Other | 1 | CompensationProcessOther |
| Investment In Joint Venture | 0 | InvestmentInJointVenture |
| Upon Request | X | UponRequest |
The Books Are In Care Of TheBooksAreInCareOf
Name Business NameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Renae Tisdall | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Telephone Number | 6058458164 | TelephoneNumber |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO Box 580 | AddressLine1 |
| City | Mobridge | City |
| State | SD | State |
| ZIP Code | 57601 | ZIPCode |
Form990 Part VII Section A Form990PartVIISectionA (19 entries)
| TitleTitle | Average Hours Per WeekAverageHoursPerWeek | Individual Trustee Or DirectorIndividualTrusteeOrDirector | OfficerOfficer | Reportable Comp From OrganizationReportableCompFromOrganization | Reportable Comp From Related OrgsReportableCompFromRelatedOrgs | Other CompensationOtherCompensation | Highest Compensated EmployeeHighestCompensatedEmployee |
|---|---|---|---|---|---|---|---|
| Dennis Schnabel | |||||||
| Chairman | 1.00 | X | X | 0 | 0 | 0 | |
| Delphine Steuck | |||||||
| Vice Chair | 1.00 | X | X | 0 | 0 | 0 | |
| Bill Bachmeier | |||||||
| Treasurer | 1.00 | X | X | 0 | 0 | 0 | |
| Heidi Roshau | |||||||
| Secretary | 1.00 | X | X | 0 | 0 | 0 | |
| Jake Kraft | |||||||
| Director | 1.00 | X | 0 | 0 | 0 | ||
| Wally Schott | |||||||
| Director | 1.00 | X | 0 | 0 | 0 | ||
| Donald Paulson | |||||||
| Director | 1.00 | X | 0 | 0 | 0 | ||
| Dr Leonard Linde | |||||||
| Director | 1.00 | X | 0 | 0 | 0 | ||
| Barb Gross | |||||||
| Director | 1.00 | X | 0 | 0 | 0 | ||
| Dr Tom Swanson | |||||||
| Director | 1.00 | X | 0 | 0 | 0 | ||
| Dr Travis Henderson | |||||||
| Physician/Director | 40.00 | X | 240604 | 0 | 27282 | ||
| Dr Robert Marciano | |||||||
| Physician/Director | 40.00 | X | 290415 | 0 | 20211 | ||
| Angelia Svihovec | |||||||
| CEO | 40.00 | X | 0 | 0 | 0 | ||
| Renae Tisdall | |||||||
| CFO | 40.00 | X | 74845 | 0 | 25483 | ||
| Dr Bela Csaki | |||||||
| Physician | 40.00 | 298809 | 0 | 20718 | X | ||
| Dr Colette Reule | |||||||
| Physician | 40.00 | 267561 | 0 | 24746 | X | ||
| Dr Kenric Malmberg | |||||||
| Physician | 40.00 | 234092 | 0 | 24129 | X | ||
| Debbie Smith | |||||||
| CRNA | 40.00 | 194520 | 0 | 16517 | X | ||
| Dr Josh Henderson | |||||||
| Physician | 40.00 | 204031 | 0 | 21753 | X | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 1804877 | TotalReportableCompFromOrg |
| Total Reportable Comp Frm Rltd Orgs | 0 | TotalReportableCompFrmRltdOrgs |
| Total Other Compensation | 180839 | TotalOtherCompensation |
| Number Individuals GT100 K | 10 | NumberIndividualsGT100K |
| Formers Listed | 0 | FormersListed |
| Total Comp GT150 K | 1 | TotalCompGT150K |
| Compensation From Other Sources | 0 | CompensationFromOtherSources |
Contractor Compensation ContractorCompensation (5 entries)
| Address Line1AddressOfContractor/AddressUS/AddressLine1 | CityAddressOfContractor/AddressUS/City | StateAddressOfContractor/AddressUS/State | ZIP CodeAddressOfContractor/AddressUS/ZIPCode | Description Of ServicesDescriptionOfServices | CompensationCompensation |
|---|---|---|---|---|---|
| CPI Group | |||||
| 7400 E Orchard Rd 270 | Greenwood Village | CO | 80111 | Architect Services | 286044 |
| St Alexius Medical Center | |||||
| 900 East Broadway | Bismarck | ND | 58506 | IT services, CEO salary, supplies, etc | 211993 |
| Johnson Controls | |||||
| PO Box 730068 | Dallas | TX | 75373 | Construction | 179395 |
| Mondak Imaging Services | |||||
| 11 South 7th St 241 | Miles City | MT | 59301 | MRI services | 134589 |
| Northern Plains Lab | |||||
| PO Box 2036 | Bismarck | ND | 58502 | Outsource laboratory services | 119442 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Contractors GT100 K | 5 | NumberOfContractorsGT100K |
| Government Grants | 1038582 | GovernmentGrants |
| All Other Contributions | 368385 | AllOtherContributions |
| Total Contributions | 1406967 | TotalContributions |
Program Service Revenue ProgramServiceRevenue (4 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome |
|---|---|---|---|
| Patient Service Revenue | 623110 | 15490348 | 15490348 |
| Assisted Living Revenue | 623110 | 475628 | 475628 |
| Ancillary Charges | 900099 | 141822 | 141822 |
| Chng in Fdtn Int | 900099 | 114221 | 114221 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | 16222019 | TotalProgramServiceRevenue |
Investment Income InvestmentIncome
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 51632 | TotalRevenueColumn |
| Exclusion | $51,632 | ExclusionAmount |
Gross Rents GrossRents
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 79290 | Real |
Less Rental Expenses LessRentalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 0 | Real |
Rental Income Or Loss RentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 79290 | Real |
Net Rental Income Or Loss NetRentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 79290 | TotalRevenueColumn |
| Exclusion | $79,290 | ExclusionAmount |
Gross Amount Sales Assets GrossAmountSalesAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 1526194 | Securities |
Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 1526194 | Securities |
Gain Or Loss GainOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 0 | Securities |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 17759908 | TotalRevenueColumn |
| Related Or Exempt Function Income | 16222019 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 0 | UnrelatedBusinessRevenue |
| Exclusion | $130,922 | ExclusionAmount |
Comp Current Officers Directors CompCurrentOfficersDirectors
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 665924 | Total |
| Program Services | 563347 | ProgramServices |
| Management And General | 102577 | ManagementAndGeneral |
Other Salaries And Wages OtherSalariesAndWages
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 7010459 | Total |
| Program Services | 6334765 | ProgramServices |
| Management And General | 675694 | ManagementAndGeneral |
Pension Plan Contributions PensionPlanContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 235405 | Total |
| Program Services | 213003 | ProgramServices |
| Management And General | 22402 | ManagementAndGeneral |
Other Employee Benefits OtherEmployeeBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 995399 | Total |
| Program Services | 995399 | ProgramServices |
Payroll Taxes PayrollTaxes
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 489515 | Total |
| Program Services | 434824 | ProgramServices |
| Management And General | 54691 | ManagementAndGeneral |
Fees For Services Management FeesForServicesManagement
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 204336 | Total |
| Management And General | 204336 | ManagementAndGeneral |
Fees For Services Legal FeesForServicesLegal
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 5203 | Total |
| Management And General | 5203 | ManagementAndGeneral |
Fees For Services Accounting FeesForServicesAccounting
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 35307 | Total |
| Management And General | 35307 | ManagementAndGeneral |
Fees For Services Other FeesForServicesOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 564125 | Total |
| Program Services | 564125 | ProgramServices |
Advertising Advertising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 80547 | Total |
| Program Services | 5274 | ProgramServices |
| Management And General | 75273 | ManagementAndGeneral |
Office Expenses OfficeExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 225286 | Total |
| Program Services | 97392 | ProgramServices |
| Management And General | 127894 | ManagementAndGeneral |
Information Technology InformationTechnology
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 78363 | Total |
| Program Services | 11847 | ProgramServices |
| Management And General | 66516 | ManagementAndGeneral |
Occupancy Occupancy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 263261 | Total |
| Program Services | 259346 | ProgramServices |
| Management And General | 3915 | ManagementAndGeneral |
Travel Travel
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 40441 | Total |
| Program Services | 40441 | ProgramServices |
Conferences Meetings ConferencesMeetings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 55943 | Total |
| Program Services | 54047 | ProgramServices |
| Management And General | 1896 | ManagementAndGeneral |
Interest Interest
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 238388 | Total |
| Program Services | 35 | ProgramServices |
| Management And General | 238353 | ManagementAndGeneral |
Depreciation Depletion DepreciationDepletion
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1431028 | Total |
| Program Services | 1431028 | ProgramServices |
Insurance Insurance
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 155494 | Total |
| Program Services | 66542 | ProgramServices |
| Management And General | 88952 | ManagementAndGeneral |
Other Expenses OtherExpenses (4 entries)
| DescriptionDescription | TotalTotal | Program ServicesProgramServices | Management And GeneralManagementAndGeneral |
|---|---|---|---|
| MEDICAL SUPPLIES | 1814288 | 1814288 | |
| BAD DEBT | 1210404 | 1210404 | |
| EQUIPMENT AND MAINTENAN | 898299 | 872426 | 25873 |
| DUES AND SUBSCRIPTIONS | 60065 | 19076 | 40989 |
All Other Expenses AllOtherExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 57052 | Total |
| Program Services | 43001 | ProgramServices |
| Management And General | 14051 | ManagementAndGeneral |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 16814532 | Total |
| Program Services | 15030610 | ProgramServices |
| Management And General | 1783922 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Savings And Temp Cash Investments SavingsAndTempCashInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 4831323 | BOY |
| EOY | 3183801 | EOY |
Accounts Receivable AccountsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2644276 | BOY |
| EOY | 4895950 | EOY |
Other Notes Loans Receivable Net OtherNotesLoansReceivableNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 30296 | BOY |
| EOY | 30054 | EOY |
Inventories For Sale Or Use InventoriesForSaleOrUse
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 492886 | BOY |
| EOY | 514594 | EOY |
Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 140917 | BOY |
| EOY | 183699 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Buildings Equipment Basis | 24465233 | LandBuildingsEquipmentBasis |
| Land Bldg Equipment Accum Deprec | 14424053 | LandBldgEquipmentAccumDeprec |
Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 8308619 | BOY |
| EOY | 10041180 | EOY |
Investments Other Securities InvestmentsOtherSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 658277 | BOY |
| EOY | 835513 | EOY |
Other Assets Total OtherAssetsTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 701388 | BOY |
| EOY | 694233 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 17807982 | BOY |
| EOY | 20379024 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1391633 | BOY |
| EOY | 1665770 | EOY |
Deferred Revenue DeferredRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 19000 | BOY |
| EOY | 1524527 | EOY |
Tax Exempt Bond Liabilities TaxExemptBondLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 4450000 | BOY |
| EOY | 4130000 | EOY |
Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 327784 | BOY |
| EOY | 431990 | EOY |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 202512 | BOY |
| EOY | 264308 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 6390929 | BOY |
| EOY | 8016595 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Unrestricted Net Assets UnrestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 10812795 | BOY |
| EOY | 11683291 | EOY |
Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 604258 | BOY |
| EOY | 679138 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 11417053 | BOY |
| EOY | 12362429 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 17807982 | BOY |
| EOY | 20379024 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expenses | 945376 | ReconcilationRevenueExpenses |
| Reconcilation Other Changes | 0 | ReconcilationOtherChanges |
| Method Of Accounting Accrual | X | MethodOfAccountingAccrual |
| Accountant Compile Or Review | 0 | AccountantCompileOrReview |
| FS Audited | 1 | FSAudited |
FS Audited Basis FSAuditedBasis
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Statement Separate | X | FinancialStatementSeparate |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | 1 | AuditCommittee |
| Federal Grant Audit Required | 1 | FederalGrantAuditRequired |
| Federal Grant Audit Performed | 1 | FederalGrantAuditPerformed |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital170b1 Aiii | X | Hospital170b1Aiii |
Schedule B IRS990ScheduleB
Contributor Info ContributorInfo
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor Number | RESTRICTED | ContributorNumber |
Contributor Name Business ContributorNameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor Address US ContributorAddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Aggregate Contributions | RESTRICTED | AggregateContributions |
Schedule D IRS990ScheduleD
Land Land
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 95575 | OtherCostOrOtherBasis |
| Book Value | 95575 | BookValue |
Buildings Buildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 10598081 | OtherCostOrOtherBasis |
| Depreciation | 6843062 | Depreciation |
| Book Value | 3755019 | BookValue |
Equipment Equipment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 11607346 | OtherCostOrOtherBasis |
| Depreciation | 7288842 | Depreciation |
| Book Value | 4318504 | BookValue |
Other Land Buildings OtherLandBuildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 2164231 | OtherCostOrOtherBasis |
| Depreciation | 292149 | Depreciation |
| Book Value | 1872082 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Land Buildings | 10041180 | TotalOfBookValueLandBuildings |
Other Liabilities OtherLiabilities (2 entries)
| DescriptionDescription | AmountAmount |
|---|---|
| Premium on Bonds Payable | $11,176 |
| Deferred Compensation Plan Payable | $253,132 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Amounts | 264308 | TotalOfAmounts |
| Footnote In Part XIII | X | FootnoteInPartXIII |
| Tot Revenue Etc Audited Fincl Stmt | 16549504 | TotRevenueEtcAuditedFinclStmt |
| Other Revenues | -1210404 | OtherRevenues |
| Revenue Not Rptd F990 | -1210404 | RevenueNotRptdF990 |
| Revenue Subtotal | 17759908 | RevenueSubtotal |
| Revenue Not Rptd On Fin Stmt | 0 | RevenueNotRptdOnFinStmt |
| Total Revenue Per Form990 | 17759908 | TotalRevenuePerForm990 |
| Tot Expenses Etc Audited Fincl Stmt | 15604128 | TotExpensesEtcAuditedFinclStmt |
| Expenses Not Rptd F990 | 0 | ExpensesNotRptdF990 |
| Expenses Subtotal | 15604128 | ExpensesSubtotal |
| Other Expenses Not Included | 1210404 | OtherExpensesNotIncluded |
| Expenses Not Rptd On Fin Stmt | 1210404 | ExpensesNotRptdOnFinStmt |
| Total Expenses Per Form990 | 16814532 | TotalExpensesPerForm990 |
Form990 Schedule D Part XIII Form990ScheduleDPartXIII (3 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| Description of Uncertain Tax Positions Under FIN 48: | Part X, Line 2: | The Organization is 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 Hospital 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 would recognize future accrued interest and penalties related to unrecognized tax benefits and liabilities in income tax expense if such interest and penalties are incurred. |
| Part XI, Line 2d - Other Adjustments: | Bad Debt Reclassified as Expense -1,210,404. | |
| Part XII, Line 4b - Other Adjustments: | Bad Debt Reclassified as Expense 1,210,404. |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Charity Care Policy | 1 | CharityCarePolicy |
| Written Policy | 1 | WrittenPolicy |
| Policy Applied To All Hospitals | X | PolicyAppliedToAllHospitals |
| FPG Reference Free Care | 0 | FPGReferenceFreeCare |
| FPG Reference Discounted Care | 1 | FPGReferenceDiscountedCare |
| Pcent300 | X | Pcent300 |
| Free Disc Care Medically Indigent | 1 | FreeDiscCareMedicallyIndigent |
| Amounts Budgeted For Charity Care | 1 | AmountsBudgetedForCharityCare |
| Expenses Exceeded Budget | 0 | ExpensesExceededBudget |
| Annual Community Benefit Report | 0 | AnnualCommunityBenefitReport |
Charity Care At Cost CharityCareAtCost
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 48000 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 48000 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00310 | PercentOfTotalExpense |
Unreimbursed Medicaid UnreimbursedMedicaid
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 2273369 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 2194661 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 78708 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00500 | PercentOfTotalExpense |
Total Charity Care TotalCharityCare
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 2321369 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 2194661 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 126708 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00810 | PercentOfTotalExpense |
Subsidized Health Services SubsidizedHealthServices
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 3169389 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 1626911 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 1542478 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.09890 | PercentOfTotalExpense |
Total Other Benefits TotalOtherBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 3169389 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 1626911 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 1542478 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.09890 | PercentOfTotalExpense |
Total Community Benefits TotalCommunityBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 5490758 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 3821572 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 1669186 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.10700 | PercentOfTotalExpense |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | 0 | BadDebtExpenseReported |
| Bad Debt Expense | $1,210,404 | BadDebtExpenseAmount |
| Amount Attributable To | 907803 | AmountAttributableTo |
| Amount Reimbursed By Medicare | 5063131 | AmountReimbursedByMedicare |
| Cost Of Care Reimbursed By Medicare | 5041041 | CostOfCareReimbursedByMedicare |
| Medicare Surplus Or Shortfall | 22090 | MedicareSurplusOrShortfall |
Costing Methodology Used CostingMethodologyUsed
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | X | Other |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | 1 | WrittenDebtCollectionPolicy |
| Provision For Charity Care | 1 | ProvisionForCharityCare |
| Number Of Hospital Facilities | 1 | NumberOfHospitalFacilities |
Form990 Schedule H Part V Section A Form990ScheduleHPartVSectionA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility Number | 1 | FacilityNumber |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Mobridge Regional Hospital | BusinessNameLine1 |
Address Address
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1401 10th Avenue W | AddressLine1 |
| City | Mobridge | City |
| State | SD | State |
| ZIP Code | 57601 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Website Address | www.mobridgehospital.org | WebsiteAddress |
| Licensed Hospital | X | LicensedHospital |
| General Medical And Surgical | X | GeneralMedicalAndSurgical |
| Critical Access Hospital | X | CriticalAccessHospital |
| Er24 Hours | X | Er24Hours |
Form990 Schedule H Part V Section B Form990ScheduleHPartVSectionB
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Mobridge Regional Hospital | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital Facility Number | 1 | HospitalFacilityNumber |
| CHNA Conducted | 1 | CHNAConducted |
| Community Definition | X | CommunityDefinition |
| Community Demographics | X | CommunityDemographics |
| Existing Resources | X | ExistingResources |
| How Data Obtained | X | HowDataObtained |
| Community Health Needs | X | CommunityHealthNeeds |
| Other Health Issues | X | OtherHealthIssues |
| Needs Assessment Conducted | 12 | NeedsAssessmentConducted |
| Take Into Account | 1 | TakeIntoAccount |
| Other Facilities | 0 | OtherFacilities |
| CHNA Widely Available | 1 | CHNAWidelyAvailable |
| Own Website | X | OwnWebsite |
| On Request | X | OnRequest |
| Adopt Implement Strategy | X | AdoptImplementStrategy |
| Prioritize Health Needs | X | PrioritizeHealthNeeds |
| Prioritize Services | X | PrioritizeServices |
| Other Needs Addressed | X | OtherNeedsAddressed |
| All Needs Addressed | 0 | AllNeedsAddressed |
| Organization Incur Excise Tax | 0 | OrganizationIncurExciseTax |
| Eligibility Criteria Explained | 1 | EligibilityCriteriaExplained |
| Uses FPG Free | 0 | UsesFPGFree |
| Uses FPG Discounted | 1 | UsesFPGDiscounted |
| FPG Discount Percent | 300.000000000000 | FPGDiscountPercent |
| Explains Basis | 1 | ExplainsBasis |
| Income Level | X | IncomeLevel |
| Asset Level | X | AssetLevel |
| Medical Indigency | X | MedicalIndigency |
| Insurance Status | X | InsuranceStatus |
| Explains Application Method | 1 | ExplainsApplicationMethod |
| Includes Publicity Measures | 1 | IncludesPublicityMeasures |
| Attached To Invoices | X | AttachedToInvoices |
| Posted In Emergency Room | X | PostedInEmergencyRoom |
| Posted In Admission Office | X | PostedInAdmissionOffice |
| Available On Request | X | AvailableOnRequest |
| Other Publicity | X | OtherPublicity |
| Actions On Nonpayment | 1 | ActionsOnNonpayment |
| Collection Activities | 0 | CollectionActivities |
| Notify Upon Admission | X | NotifyUponAdmission |
| Notified All Patients | X | NotifiedAllPatients |
| Documented Determination | X | DocumentedDetermination |
| Other Actions Taken | X | OtherActionsTaken |
| Nondiscrim Emergency Care Policy | 1 | NondiscrimEmergencyCarePolicy |
| Used Other Method | X | UsedOtherMethod |
| Amounts Generally Billed | 1 | AmountsGenerallyBilled |
| Gross Charges | 1 | GrossCharges |
Form990 Schedule H Part V Section C Form990ScheduleHPartVSectionC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Other Facilities | 4 | NumberOfOtherFacilities |
Other Facilities OtherFacilities (4 entries)
| Address Line1Address/AddressLine1 | CityAddress/City | StateAddress/State | ZIP CodeAddress/ZIPCode | Facility TypeFacilityType |
|---|---|---|---|---|
| Prairie Sunset Village | ||||
| 1320 W Grand Xing | Mobridge | SD | 57601 | Assisted Living & Senior Housing |
| Mobridge Medical Clinic | ||||
| 1309 10th Ave W | Mobridge | SD | 57601 | Provider Based Rural Health Clinic |
| West River Health Clinic | ||||
| 103 1st Avenue E | McLaughlin | SD | 57642 | Provider Based Rural Health Clinic |
| West Dakota Health Clinic | ||||
| 906 Main | Timber Lake | SD | 57656 | Provider Based Rural Health Clinic |
Form990 Schedule H Part VI Form990ScheduleHPartVI (20 entries)
| ExplanationExplanation | IdentifierIdentifier |
|---|---|
| Part I, Line 3c: MRH offers financial assistance discounts of up to 85% based on FPG. Please refer to Part V, Line 12 for other factors used in determining financial assistance eligibility. | |
| Part I, Line 7: Charity care expense was converted to cost on line 7a based on an overall cost-to-charge ratio addressing all patient segments. Line 7b was determined using the Medicaid PS&R report and the general ledger accounting system. Line 7g was determined using the Medicare cost report for fiscal year ending 9/30/13. | |
| Part I, L7 Col(f): Bad debt expense of $1,210,404 was subtracted from total operating expense. | |
| Part III, Line 4: a) Bad debt expense on Part III Lines 2 and 3 is based on charges. When a payment is received or a discount given on a bad debt account it offsets the current fiscal year bad debt expense through a recovery of bad debt account. b) Bad debt expense attributable to financial assistance is estimated based on income levels. A large portion of MRH charges are generated by those below the poverty level. Statistics prove that most of the mentioned patients qualify for financial assistance. After review, MRH estimates approximately 75% of bad debt at cost is attributable to persons who would qualify for financial assistance. c) The footnote for bad debt expense is located on page 7 of the attached audited financial statements. | |
| Part III, Line 8: Medicare Allowable Cost of Care was calculated from the Medicare Cost Report for fiscal year ending 9/30/13. | |
| Part III, Line 9b: The patient account specialist at the Mobridge Regional Hospital keeps on file all guarantors who have qualified for financial assistance and applies the financial assistance to all accounts when the guarantor balance becomes due. Updated financial information is requested annually for any changes in financial assistance that may apply. | |
| Part V, Section B, Line 3: The facility obtained data for the community health needs assessment through focus groups, surveys and personal interviews involving community leaders, community healthcare providers, coordinating agencies, community members and the underserved population. | Mobridge Regional Hospital |
| Part V, Section B, Line 5c: The Organization's CHNA can be accessed at: www.mobridgehospital.org/community-outreach/Part V, Section B, Line 6:The Organization's Implementation Strategy can be accessed at www.mobridgehospital.org/community-outreach/. | Mobridge Regional Hospital |
| Part V, Section B, Line 6i: Financial feasibility studies for identified needs were completed by St. Alexius Medical Center. | Mobridge Regional Hospital |
| Part V, Section B, Line 7: Pursuant to the implementation strategy adopted by Mobridge Regional Hospital, providing cancer care and kidney dialysis will not be addressed. Because of Mobridge's size, the ability to recruit and retain physicians to provide cancer care and highly specialized care is nearly impossible. Financial feasibility studies were completed for needs identified. We found the cost to add kidney dialysis was far too great and we are therefore unable to provide this particular service. Additionally, the community had a concern regarding travel for the treatment of cancer. The Organization has and continues to meet the need of helping patients with travel expenses by supporting the local cancer foundation. | Mobridge Regional Hospital |
| Part V, Section B, Line 10: MRH offers financial assistance discounts of up to 85% based on FPG. | Mobridge Regional Hospital |
| Part V, Section B, Line 14g: A financial assistance notice is made part of the billing invoice. A financial assistance notice is posted in the emergency room, waiting rooms, and admissions office, and the full policy is made available upon request. | Mobridge Regional Hospital |
| Part V, Section B, Line 18e: Provided financial assistance information with patient discharge materials. | Mobridge Regional Hospital |
| Part V, Section B, Line 20d: The maximum amount charged to a patient under the financial assistance policy for emergency and medically necessary care is 50% of the gross charges. This is based on the lowest discount under the charity care policy of 50%. The Financial Assistance Policy is being updated to comply with Section 501(r). This will be completed at least by September 30, 2014. | Mobridge Regional Hospital |
| Part V, Section B, Line 21: The hospital provides a reduction to gross charges under the following conditions: patients indicate they have family income of no more than 300% of FPG, are uninsured or underinsured, and complete the required paperwork to be eligible for financial assistance.The hospital has not determined the amount generally billed under the various proposed methods of calculation. Therefore, it is possible a patient under the financial assistance policy could have paid more than the amount generally billed. The Financial Assistance Policy is being updated to comply with Section 501(r). This will be completed at least by September 30, 2014. | Mobridge Regional Hospital |
| Part V, Section B, Line 22: The financial assistance policy covers medically necessary services only. Therefore, the hospital may have charged FAP-eligible individuals an amount equal to gross charges for nonmedically necessary services. | Mobridge Regional Hospital |
| Part VI, Line 2: Mobridge Regional Hospital (MRH) is committed to providing high quality healthcare services to all people throughout the region. The facility provides family medicine, internal medicine, OB, ICU, ALS, ambulance service, emergency care, and surgical services to all people who are in need of those services. MRH currently is working in collaboration with Walworth County and the State of South Dakota to provide Community Health Services, including family planning services, adult health, and child immunizations. MRH's management strives to listen to the community needs. If new healthcare needs arise, administration will complete an analysis of cost/benefit for the new service to be offered. MRH's administration believes in being out in the public at events to answer questions that may surface about the facility. During the year ended 9/30/13 the community health needs assessment was completed. Please see Schedule H Part V for more information. | |
| Part VI, Line 3: MRH posts its financial assistance policy, or a summary thereof, and financial assistance contact information in the admissions areas and clinic areas in which eligible patients are likely to be present. The facility provides a copy of the policy, or a summary thereof, and financial assistance contact information to patients with discharge materials. The Patients Account Manager discusses with the patient the availability of various government benefits, such as Medicaid or state programs, and assists the patient with qualification for such programs, where applicable.MRH's financial assistance program is available to both new and established patients. The financial assistance policy covers all medically necessary services provided by the institution that are ordered by physicians.MRH's financial assistance program is available to all patients who indicate an inability to pay and meet the criteria as established by the hospital for all or a portion of their outstanding hospital bill. | |
| Part VI, Line 4: MRH is located in a small rural community in Walworth County, South Dakota, known as Mobridge. According to the 2010 Census, Mobridge has a population of 3,465 people racially comprised of mainly Caucasian (75.67%) and Native Americans (20.46%). The community borders the Standing Rock Reservation and the Cheyenne River Reservation which accounts for the larger Native American population and relations with Indian Health Services. The median household income of Mobridge is $37,417, and the median family income is $52,316. Roughly 17.6% of the population is below the poverty line. The facility owns and operates clinics in Mobridge, McLaughlin and Timber Lake. The facility serves patients from a six county area (Walworth, Ziebach, Corson, Dewey, Campbell and Potter) and is approximately one hundred miles from another hospital with a higher level of care offered. According to the 2010 Census, Ziebach county is the poorest county in America, and 62% of people living in this county are under federal poverty guidelines. Corson County ranked 9th of the poorest counties in America. The poverty level in Mobridge is 59.1% greater than the South Dakota average and 75.5% greater than the National average. The median earnings for males is 50.3% greater than the median earnings for females in Mobridge. | |
| Part VI, Line 5: The Mobridge Regional Hospital is committed to the patients we serve, regardless of race, color, religion, sex, disability, or ability to pay. The organization's financial assistance adjustments have continued to trend up over the past few years, and we continue to focus budget efforts to continue this trend. MRH is 100 miles from another healthcare facility with a higher level of care and participates in the North Dakota and South Dakota trauma systems with level III and level IV certifications, respectively. MRH continues a broad level of board involvement for Corson, Dewey, and Walworth Counties to monitor community needs in those areas. MRH continues to be a popular place for medical students to complete clinical rotations, and we continue to offer a wide variety of certification classes to nurses and the members of the community including EMT-B, PALS, ACLS, TNCC, ALSO, NALS, EMT-I, and CPR. MRH has developed a worksite wellness program within the organization and has goals to work with other businesses in the community to promote overall healthy lifestyles.MRH provides various health screenings available to the community and surrounding communities throughout the year. The health screenings include free cholesterol checks, BMI, blood pressure and waist/hip ratios. These preventative health screenings promote the general health of the community.The hospital has a Board of Directors comprised of volunteers who reside in the service area. Medical staff privileges are extended to all qualified physicians in the area. All qualified physicians who show an interest must go through a credential review and board approval. Surplus funds, if available, are reinvested in the facilities to improve patient care. |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Compensation Survey | X | CompensationSurvey |
| Board Or Committee Approval | X | BoardOrCommitteeApproval |
| Severance Payment | 0 | SeverancePayment |
| Supplemental Nonqual Retire Plan | 0 | SupplementalNonqualRetirePlan |
| Equity Based Comp Arrangement | 0 | EquityBasedCompArrangement |
| Comp Based On Revenue Of Filing Org | 0 | CompBasedOnRevenueOfFilingOrg |
| Comp Based On Revenue Related Orgs | 0 | CompBasedOnRevenueRelatedOrgs |
| Comp Based Net Earnings Filing Org | 0 | CompBasedNetEarningsFilingOrg |
| Comp Based Net Earnings Relate Orgs | 0 | CompBasedNetEarningsRelateOrgs |
| Any Non Fixed Payments | 1 | AnyNonFixedPayments |
| Initial Contract Exception | 0 | InitialContractException |
Form990 Schedule J Part II Form990ScheduleJPartII (7 entries)
| TitleTitle | Base Compensation Filing OrgBaseCompensationFilingOrg | Comp Based On Related OrgsCompBasedOnRelatedOrgs | Bonus Filing OrgBonusFilingOrg | Bonus Related OrgsBonusRelatedOrgs | Other Compensation Filing OrgOtherCompensationFilingOrg | Other Compensation Related OrgsOtherCompensationRelatedOrgs | Deferred Comp Filing OrgDeferredCompFilingOrg | Deferred Comp Related OrgsDeferredCompRelatedOrgs | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrg | Nontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgs | Total Compensation Filing OrgTotalCompensationFilingOrg | Total Compensation Related OrgsTotalCompensationRelatedOrgs | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrg | Comp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Dr Travis Henderson | ||||||||||||||
| Physician/Director | 212791 | 0 | 22529 | 0 | 5284 | 0 | 9533 | 0 | 18146 | 0 | 268283 | 0 | 0 | 0 |
| Dr Robert Marciano | ||||||||||||||
| Physician/Director | 229571 | 0 | 56276 | 0 | 4568 | 0 | 10000 | 0 | 10633 | 0 | 311048 | 0 | 0 | 0 |
| Dr Bela Csaki | ||||||||||||||
| Physician | 289384 | 0 | 0 | 0 | 9425 | 0 | 10000 | 0 | 11297 | 0 | 320106 | 0 | 0 | 0 |
| Dr Colette Reule | ||||||||||||||
| Physician | 215482 | 0 | 46426 | 0 | 5653 | 0 | 10000 | 0 | 15082 | 0 | 292643 | 0 | 0 | 0 |
| Dr Kenric Malmberg | ||||||||||||||
| Physician | 193068 | 0 | 35493 | 0 | 5531 | 0 | 9150 | 0 | 15321 | 0 | 258563 | 0 | 0 | 0 |
| Debbie Smith | ||||||||||||||
| CRNA | 195004 | 0 | 0 | 0 | -484 | 0 | 7932 | 0 | 8974 | 0 | 211426 | 0 | 0 | 0 |
| Dr Josh Henderson | ||||||||||||||
| Physician | 193035 | 0 | 5251 | 0 | 5745 | 0 | 7183 | 0 | 14906 | 0 | 226120 | 0 | 0 | 0 |
Form990 Schedule J Part III Form990ScheduleJPartIII
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Reference | Part I, Line 7 | ReturnReference |
| Explanation | The physicians are paid based on relative value unit based production. | Explanation |
Schedule K IRS990ScheduleK
Form990 Schedule K Part I Form990ScheduleKPartI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
Issuer Name IssuerName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | City of Mobridge South Dakota | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Issuer EIN | 466000320 | IssuerEIN |
| CUSIP Number | 607429BA4 | CUSIPNumber |
| Date Issued | 2007-05-08 | DateIssued |
| Issue Price | 5773898 | IssuePrice |
| Description Of Purpose | Refinance bonds issued 1997 used for construction; purchase CT, Clinic & EMR | DescriptionOfPurpose |
| Defeased | 0 | Defeased |
| On Behalf Of Issuer | 0 | OnBehalfOfIssuer |
| Pool Financing | 0 | PoolFinancing |
Form990 Schedule K Part II Form990ScheduleKPartII
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Amount Retired | 1625000 | AmountRetired |
| Total Proceeds | 5773898 | TotalProceeds |
| Amount In Reserve Fund | 267790 | AmountInReserveFund |
| Issuance Costs From Proceeds | 88005 | IssuanceCostsFromProceeds |
| Capital Expenditures | 1000000 | CapitalExpenditures |
| Other Spent Proceeds | 4416499 | OtherSpentProceeds |
| Year Of Subst Completion | 2008 | YearOfSubstCompletion |
| Current Refunding | 0 | CurrentRefunding |
| Advance Refunding | 1 | AdvanceRefunding |
| Final Allocation Made | 1 | FinalAllocationMade |
| Adequate Books And Recds Maintaind | 1 | AdequateBooksAndRecdsMaintaind |
Form990 Schedule K Part III Form990ScheduleKPartIII
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Owning Bond Financed Property | 0 | OwningBondFinancedProperty |
| Any Lease Arrangements | 0 | AnyLeaseArrangements |
| Mngment Cntrct Bond Financd Prprty | 0 | MngmentCntrctBondFinancdPrprty |
| Any Research Agreements | 0 | AnyResearchAgreements |
| Prcntge Prvt Business Use By Others | 0.00000 | PrcntgePrvtBusinessUseByOthers |
| Percentage Of Prvt Business Re UBI | 0.00000 | PercentageOfPrvtBusinessReUBI |
| Total Private Business Use | 0.00000 | TotalPrivateBusinessUse |
| Bond Iss Meet Prvt Security Pay Test | 0 | BondIssMeetPrvtSecurityPayTest |
| Change In Use Bond Financed Prop | 0 | ChangeInUseBondFinancedProp |
| Non Qualified Bond Remed Procdrs | 1 | NonQualifiedBondRemedProcdrs |
Form990 Schedule K Part IV Form990ScheduleKPartIV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Form8038 T Filed | 0 | Form8038TFiled |
| Rebate Not Due Yet | 0 | RebateNotDueYet |
| Exception To Rebate | 0 | ExceptionToRebate |
| No Rebate Due | 1 | NoRebateDue |
| Variable Rate Issue | 0 | VariableRateIssue |
| Hedge Identified In Books And Recds | 0 | HedgeIdentifiedInBooksAndRecds |
| Gross Proceeds Invested In GIC | 0 | GrossProceedsInvestedInGIC |
| Gross Proceeds Invested | 0 | GrossProceedsInvested |
| Written Proc To Monitor Reqs | 0 | WrittenProcToMonitorReqs |
Form990 Schedule K Part VI Form990ScheduleKPartVI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | Schedule K Part IV, Arbitrage, Line 2c | Identifier |
| Return Reference | Date Rebate Computation Performed | ReturnReference |
| Explanation | Issuer Name: City of Mobridge, South Dakota Date the Rebate Computation was Performed: 07/13/2012 | Explanation |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (8 entries)
| Return ReferenceReturnReference | ExplanationExplanation |
|---|---|
| Form 990, Part VI, Section A, line 3 | MRH currently has a management agreement with St. Alexius Medical Center in Bismarck, ND. The agreement provides the CEO, Angelia K. Svihovec, and information technology support at a cost to MRH. The original management agreement date was January 1, 2000. Angelia Svihovec, CEO, received W-2 compensation of $152,413 during the calendar year ended 12/31/12. |
| Form 990, Part VI, Section A, line 6 | There is only one class of member; all members have one vote (same voting rights). |
| Form 990, Part VI, Section A, line 7a | The nominating committee nominates candidates for election. The members vote on candidates at the annual meeting. |
| Form 990, Part VI, Section A, line 8b | There is no committee with the authority to act on behalf of the governing body. |
| Form 990, Part VI, Section B, line 11 | The CEO, CFO, and Finance Committee will review the Form 990 prior to filing with the IRS. |
| Form 990, Part VI, Section B, line 12c | The conflict of interest policy covers the entire Board of Directors. If a conflict should arise, it would first go to the CEO for evaluation, then to the Board of Directors for final evaluation. The Board of Directors is responsible for making the final decision in determining if a conflict exists. If a conflict is found, the person(s) involved would be required to abstain from discussions and voting on the item causing the conflict. |
| Form 990, Part VI, Section B, line 15 | The Finance Committee determines and approves the physician contracts, including compensation. The CEO's salary is determined using a salary survey and discussions with the management company. The Finance Committee approves the salary of the CEO annually. The Board of Directors approves the Finance Committee minutes, which include discussions regarding the CEO's salary. Salaries for other Officers or members of management are determined by the CEO through the use of salary survey information from SDAHO and employee service and experience files. Salary increases were implemented on September 8th, 2013. |
| Form 990, Part VI, Section C, line 19 | Documents are made available upon request. |
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