COTEAU DES PRAIRIES HOSPITAL: Form 990, tax year 2013
View the entire original 990 at ProPublica ↗
- Organization
- COTEAU DES PRAIRIES HOSPITAL (EIN 46-0278210)
- Tax period
- 2013-01-01 to 2013-12-31
- Filed
- 2014-11-14
- IRS object ID
- 201423189349305302
- Schema version
- 2013v3.0
- 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 | 2014-11-14T13:10:00-06:00 | ReturnTs |
| Tax Period End | 2013-12-31 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 450250958 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Eide Bailly LLP | BusinessNameLine1 |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 200 East 10th Suite 500 | AddressLine1 |
| City | Sioux Falls | City |
| State | SD | State |
| ZIP Code | 571045126 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2013-01-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 460278210 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Coteau des Prairies Hospital | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | COTE | BusinessNameControlTxt |
| Phone | 6056987647 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 205 Orchard Drive | AddressLine1 |
| City | Sisseton | City |
| State | SD | State |
| ZIP Code | 572622398 | ZIPCode |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | Dan Ellis | PersonNm |
| Person Title | CEO | PersonTitleTxt |
| Phone | 6056987647 | PhoneNum |
| Signature | 2014-11-14 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | Laurie Hanson | PreparerPersonNm |
| PTIN | P00851848 | PTIN |
| Phone | 6053391999 | PhoneNum |
| Preparation | 2014-11-14 | PreparationDt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2013 | TaxYr |
| Build TS | 2015-11-30 17:44:51Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | Dan Ellis | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 205 Orchard Drive | AddressLine1 |
| City | Sisseton | City |
| State | SD | State |
| ZIP Code | 572622398 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $14,051,898 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | www.cdphospital.com | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1967 | FormationYr |
| Legal Domicile State | SD | LegalDomicileStateCd |
| Activity Or Mission | Provision of healthcare services to the population of Sisseton, SD, and the surrounding area. | ActivityOrMissionDesc |
| Voting Members Governing Body | 12 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 12 | VotingMembersIndependentCnt |
| Total Employee | 178 | TotalEmployeeCnt |
| Total Volunteers | 20 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $88,129 | PYContributionsGrantsAmt |
| CY Contributions Grants | $754,301 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $13,095,018 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $13,266,451 | CYProgramServiceRevenueAmt |
| PY Investment Income | $8,371 | PYInvestmentIncomeAmt |
| CY Investment Income | -$10,668 | CYInvestmentIncomeAmt |
| PY Other Revenue | $18,171 | PYOtherRevenueAmt |
| CY Other Revenue | $22,327 | CYOtherRevenueAmt |
| PY Total Revenue | $13,209,689 | PYTotalRevenueAmt |
| CY Total Revenue | $14,032,411 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $0 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $2,375 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $7,074,864 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $7,374,778 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $5,587,819 | PYOtherExpensesAmt |
| CY Other Expenses | $6,075,450 | CYOtherExpensesAmt |
| PY Total Expenses | $12,662,683 | PYTotalExpensesAmt |
| CY Total Expenses | $13,452,603 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $547,006 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $579,808 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $9,284,464 | TotalAssetsBOYAmt |
| Total Assets EOY | $16,804,269 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $2,256,218 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $9,196,215 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $7,028,246 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $7,608,054 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | Quality Care with a Personal Touch, Close to Home. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $11,694,472 | ExpenseAmt |
| Grant | $2,375 | GrantAmt |
| Revenue | $13,266,451 | RevenueAmt |
| Desc | Coteau des Prairies Hospital (CDPH) is a 25 bed acute care hospital and physician clinics located in Sisseton, South Dakota and the surrounding area. The Hospital provides health care services to patients who meet certain criteria under its Charity Care Policy without charge or at amounts less then established rates. Since the Hospital does not pursue collection of these amounts, they are not reported as patient service revenue. The estimated cost of providing these services was $67,400 for the year ended December 31, 2013, calculated by multiplying the ratio of cost to gross charges for the Hospital by the gross uncompensated charges associated with providing charity care to its patients.Statistics for the period ended December 31, 2013, are as follows: acute patient days = 1,391, subacute patient days = 331, newborn days = 334, and emergency room visits = 4,816. | Desc |
| Total Program Service Expenses | $11,694,472 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (1) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (1) | ScheduleBRequiredInd |
| Political Campaign Acty | 0 | PoliticalCampaignActyInd |
| Lobbying Activities | 0 | LobbyingActivitiesInd |
| Subject To Proxy Tax | 0 | SubjectToProxyTaxInd |
| Donor Advised Fund | 0 | DonorAdvisedFundInd |
| Conservation Easements | 0 | ConservationEasementsInd |
| Collections Of Art | 0 | CollectionsOfArtInd |
| Credit Counseling | 0 | CreditCounselingInd |
| Temp Or Permanent Endowments | 0 | TempOrPermanentEndowmentsInd |
| Report Land Building Equipment | Yes (1) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | 0 | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | 0 | ReportProgramRelatedInvstInd |
| Report Other Assets | 0 | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (1) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | Yes (1) | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | Yes (1) | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | 0 | ConsolidatedAuditFinclStmtInd |
| School Operating | 0 | SchoolOperatingInd |
| Foreign Office | 0 | ForeignOfficeInd |
| Foreign Activities | 0 | ForeignActivitiesInd |
| More Than5000 K To Org | 0 | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividualsInd |
| Professional Fundraising | 0 | ProfessionalFundraisingInd |
| Fundraising Activities | 0 | FundraisingActivitiesInd |
| Gaming Activities | 0 | GamingActivitiesInd |
| Operate Hospital | Yes (1) | OperateHospitalInd |
| Audited Financial Stmt Att | Yes (1) | AuditedFinancialStmtAttInd |
| Grants To Organizations | 0 | GrantsToOrganizationsInd |
| Grants To Individuals | 0 | GrantsToIndividualsInd |
| Schedule J Required | Yes (1) | ScheduleJRequiredInd |
| Tax Exempt Bonds | Yes (1) | TaxExemptBondsInd |
| Invest Tax Exempt Bonds | 0 | InvestTaxExemptBondsInd |
| Escrow Account | 0 | EscrowAccountInd |
| On Behalf Of Issuer | 0 | OnBehalfOfIssuerInd |
| Engaged In Excess Benefit Trans | 0 | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | 0 | PYExcessBenefitTransInd |
| Loan Outstanding | 0 | LoanOutstandingInd |
| Grant To Related Person | 0 | GrantToRelatedPersonInd |
| Business Rln With Org Mem | 0 | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | 0 | BusinessRlnWithFamMemInd |
| Business Rln With Officer Ent | 0 | BusinessRlnWithOfficerEntInd |
| Deductible Non Cash Contri | 0 | DeductibleNonCashContriInd |
| Deductible Art Contribution | 0 | DeductibleArtContributionInd |
| Terminate Operations | 0 | TerminateOperationsInd |
| Partial Liquidation | 0 | PartialLiquidationInd |
| Disregarded Entity | 0 | DisregardedEntityInd |
| Related Entity | 0 | RelatedEntityInd |
| Related Organization Ctrl Ent | 0 | RelatedOrganizationCtrlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | 0 | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| IRP Document | 22 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (1) | BackupWthldComplianceInd |
| Employee | 178 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (1) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | 0 | UnrelatedBusIncmOverLimitInd |
| Foreign Financial Account | 0 | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | 0 | TaxablePartyNotificationInd |
| Nondeductible Contributions | 0 | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributionsInd |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOfInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | 0 | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | 0 | PayPremiumsPrsnlBnftCntrctInd |
| Indoor Tanning Services | 0 | IndoorTanningServicesInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 12 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 12 | IndependentVotingMemberCnt |
| Family Or Business Rln | 0 | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | 0 | DelegationOfMgmtDutiesInd |
| Change To Org Documents | 0 | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | 0 | MembersOrStockholdersInd |
| Election Of Board Members | 0 | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | 0 | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (1) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (1) | MinutesOfCommitteesInd |
| Officer Mailing Address | 0 | OfficerMailingAddressInd |
| Local Chapters | 0 | LocalChaptersInd |
| Form990 Provided To Gvrn Body | 0 | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (1) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (1) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (1) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (1) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (1) | DocumentRetentionPolicyInd |
| Compensation Process CEO | Yes (1) | CompensationProcessCEOInd |
| Compensation Process Other | Yes (1) | CompensationProcessOtherInd |
| Investment In Joint Venture | 0 | InvestmentInJointVentureInd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Larry Moen | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 6056984697 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 205 Orchard Drive | AddressLine1 |
| City | Sisseton | City |
| State | SD | State |
| ZIP Code | 572622398 | ZIPCode |
Form990 Part VII Section A Form990PartVIISectionAGrp (19 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 |
|---|---|---|---|---|---|---|---|
| Mary Carlson | |||||||
| President | 2.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| Faye Johnston | |||||||
| Vice President | 2.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| Terry Jaspers | |||||||
| Treasurer | 2.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| Kent Thoelke | |||||||
| Secretary | 2.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| Debbie Wooley | |||||||
| Member | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| Steven McCleerey | |||||||
| Member | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| Erin Cameron | |||||||
| Member | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| Cheryl Karst | |||||||
| Member | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| Vivian Hove | |||||||
| Member | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| Geraldine Opsal | |||||||
| Member | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| Jay Hill | |||||||
| Member | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| Vern Donnell | |||||||
| Member | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| Dan Ellis | |||||||
| CEO | 40.00 | Yes (X) | $129,540 | $0 | $20,657 | ||
| Larry Moen | |||||||
| CFO | 40.00 | Yes (X) | $75,522 | $0 | $11,039 | ||
| Stanley Gallagher DO | |||||||
| Osteopathy | 40.00 | $617,231 | $0 | $7,649 | Yes (X) | ||
| Judy Beumer MD | |||||||
| OB GYN | 32.00 | $381,950 | $0 | $25,136 | Yes (X) | ||
| David Staub MD | |||||||
| Family Practice | 20.00 | $411,063 | $0 | $7,649 | Yes (X) | ||
| Linda Peterson MD FACOG | |||||||
| Family Practice | 24.00 | $167,292 | $0 | $6,917 | Yes (X) | ||
| Bradley Gallagher PA-C | |||||||
| Family Practice | 40.00 | $115,136 | $0 | $4,833 | Yes (X) | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $1,897,734 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $0 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $83,880 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 6 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | 0 | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (1) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | 0 | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp
Contractor Name ContractorName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | Charles Pryzmus | PersonNm |
Contractor Address ContractorAddress
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1004 5th Avenue North | AddressLine1 |
| City | Wheaton | City |
| State | MN | State |
| ZIP Code | 56296 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Services | Anesthesia Services | ServicesDesc |
| Compensation | $152,162 | CompensationAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 1 | CntrctRcvdGreaterThan100KCnt |
| Government Grants | $175,084 | GovernmentGrantsAmt |
| All Other Contributions | $579,217 | AllOtherContributionsAmt |
| Total Contributions | $754,301 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (3 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| Patient service revenue | 622110 | $13,226,368 | $13,226,368 |
| Cafeteria revenue | 722514 | $20,623 | $20,623 |
| Supporting revenue | 900099 | $19,460 | $19,460 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $13,266,451 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $5,816 | TotalRevenueColumnAmt |
| Exclusion | $5,816 | ExclusionAmt |
Gross Rents GrossRentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $22,327 | RealAmt |
Less Rental Expenses LessRentalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $0 | RealAmt |
Rental Income Or Loss RentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $22,327 | RealAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $22,327 | TotalRevenueColumnAmt |
| Exclusion | $22,327 | ExclusionAmt |
Gross Amount Sales Assets GrossAmountSalesAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | $3,003 | OtherAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | $19,487 | OtherAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | -$16,484 | OtherAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -$16,484 | TotalRevenueColumnAmt |
| Exclusion | -$16,484 | ExclusionAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $14,032,411 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $13,266,451 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $11,659 | ExclusionAmt |
Grants To Domestic Orgs GrantsToDomesticOrgsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,375 | TotalAmt |
| Program Services | $2,375 | ProgramServicesAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $234,034 | TotalAmt |
| Management And General | $234,034 | ManagementAndGeneralAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $5,888,375 | TotalAmt |
| Program Services | $5,361,487 | ProgramServicesAmt |
| Management And General | $526,888 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $114,684 | TotalAmt |
| Program Services | $107,230 | ProgramServicesAmt |
| Management And General | $7,454 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $671,537 | TotalAmt |
| Program Services | $610,044 | ProgramServicesAmt |
| Management And General | $61,493 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $466,148 | TotalAmt |
| Program Services | $410,154 | ProgramServicesAmt |
| Management And General | $55,994 | ManagementAndGeneralAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $31,730 | TotalAmt |
| Management And General | $31,730 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $51,990 | TotalAmt |
| Management And General | $51,990 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,249,387 | TotalAmt |
| Program Services | $1,108,315 | ProgramServicesAmt |
| Management And General | $141,072 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $43,046 | TotalAmt |
| Program Services | $4,965 | ProgramServicesAmt |
| Management And General | $38,081 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $571,354 | TotalAmt |
| Program Services | $444,066 | ProgramServicesAmt |
| Management And General | $127,288 | ManagementAndGeneralAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $342,652 | TotalAmt |
| Management And General | $342,652 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $175,522 | TotalAmt |
| Program Services | $175,522 | ProgramServicesAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $156,927 | TotalAmt |
| Program Services | $140,045 | ProgramServicesAmt |
| Management And General | $16,882 | ManagementAndGeneralAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $32,453 | TotalAmt |
| Program Services | $24,038 | ProgramServicesAmt |
| Management And General | $8,415 | ManagementAndGeneralAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $55,651 | TotalAmt |
| Program Services | $55,651 | ProgramServicesAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $452,319 | TotalAmt |
| Program Services | $452,319 | ProgramServicesAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $140,090 | TotalAmt |
| Program Services | $31,654 | ProgramServicesAmt |
| Management And General | $108,436 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| Medical Supplies | $2,244,632 | $2,244,632 | |
| Bad Debt | $409,163 | $409,163 | |
| Food | $70,945 | $70,945 | |
| License and Permits | $43,243 | $38,838 | $4,405 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $4,346 | TotalAmt |
| Program Services | $3,029 | ProgramServicesAmt |
| Management And General | $1,317 | ManagementAndGeneralAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $13,452,603 | TotalAmt |
| Program Services | $11,694,472 | ProgramServicesAmt |
| Management And General | $1,758,131 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,107,360 | BOYAmt |
| EOY | $3,009,247 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,965,623 | BOYAmt |
| EOY | $2,803,316 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $244,437 | BOYAmt |
| EOY | $248,707 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $97,814 | BOYAmt |
| EOY | $89,318 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $15,513,612 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $5,556,431 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,869,230 | BOYAmt |
| EOY | $9,957,181 | EOYAmt |
Intangible Assets IntangibleAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $80,500 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $616,000 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $9,284,464 | BOYAmt |
| EOY | $16,804,269 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,021,347 | BOYAmt |
| EOY | $942,937 | EOYAmt |
Deferred Revenue DeferredRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $163,256 | EOYAmt |
Tax Exempt Bond Liabilities TaxExemptBondLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,234,871 | BOYAmt |
| EOY | $7,381,155 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $708,867 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,256,218 | BOYAmt |
| EOY | $9,196,215 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $7,028,246 | BOYAmt |
| EOY | $7,608,054 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $7,028,246 | BOYAmt |
| EOY | $7,608,054 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $9,284,464 | BOYAmt |
| EOY | $16,804,269 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | $579,808 | ReconcilationRevenueExpnssAmt |
| Other Changes In Net Assets | $0 | OtherChangesInNetAssetsAmt |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | 0 | AccountantCompileOrReviewInd |
| FS Audited | Yes (1) | 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 (1) | AuditCommitteeInd |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequiredInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital | Yes (X) | HospitalInd |
Schedule B IRS990ScheduleB
Contributor Information ContributorInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor | RESTRICTED | ContributorNum |
Contributor Business Name ContributorBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor US Address ContributorUSAddress
| 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) |
|---|---|---|
| Total Contributions | RESTRICTED | TotalContributionsAmt |
Schedule D IRS990ScheduleD
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $13,556 | OtherCostOrOtherBasisAmt |
| Book Value | $13,556 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $10,169,498 | OtherCostOrOtherBasisAmt |
| Depreciation | $2,413,646 | DepreciationAmt |
| Book Value | $7,755,852 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $4,784,045 | OtherCostOrOtherBasisAmt |
| Depreciation | $3,033,921 | DepreciationAmt |
| Book Value | $1,750,124 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $546,513 | OtherCostOrOtherBasisAmt |
| Depreciation | $108,864 | DepreciationAmt |
| Book Value | $437,649 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $9,957,181 | TotalBookValueLandBuildingsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | Construction accounts payable | Desc |
| Amt | $708,867 | Amt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $708,867 | TotalLiabilityAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
| Total Rev Etc Audited Fincl Stmt | $13,160,434 | TotalRevEtcAuditedFinclStmtAmt |
| Other Revenue | -$409,163 | OtherRevenueAmt |
| Revenue Not Reported | -$409,163 | RevenueNotReportedAmt |
| Revenue Subtotal | $13,569,597 | RevenueSubtotalAmt |
| Other Revenues Not Included | $462,814 | OtherRevenuesNotIncludedAmt |
| Revenue Not Reported Fincl Stmt | $462,814 | RevenueNotReportedFinclStmtAmt |
| Total Revenue Per Form990 | $14,032,411 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $13,043,440 | TotExpnsEtcAuditedFinclStmtAmt |
| Expenses Not Reported | $0 | ExpensesNotReportedAmt |
| Expenses Subtotal | $13,043,440 | ExpensesSubtotalAmt |
| Other Expenses Not Included | $409,163 | OtherExpensesNotIncludedAmt |
| Expenses Not Rpt Fincl Stmt | $409,163 | ExpensesNotRptFinclStmtAmt |
| Total Expenses Per Form990 | $13,452,603 | TotalExpensesPerForm990Amt |
Supplemental Information Detail SupplementalInformationDetail (4 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Part X, Line 2: | The Hospital is organized as a South Dakota nonprofit corporation and has been recognized by the Internal Revenue Service (IRS) as exempt from federal income taxes under Internal Revenue Code Section 501(c)(3). The Hospital 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 Hospital 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 Hospital 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 Hospital 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: | Provision for bad debts included in revenue for financial statements -409,163. |
| Part XI, Line 4b - Other Adjustments: | Contributions for long-lived assets included in revenue for Form 990 462,814. |
| Part XII, Line 4b - Other Adjustments: | Provision for bad debts included in revenue for financial statements 409,163. |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Assistance Policy | Yes (1) | FinancialAssistancePolicyInd |
| Written Policy | Yes (1) | WrittenPolicyInd |
| All Hospitals Policy | Yes (X) | AllHospitalsPolicyInd |
| FPG Reference Free Care | Yes (1) | FPGReferenceFreeCareInd |
| Percent150 | Yes (X) | Percent150Ind |
| FPG Reference Discounted Care | Yes (1) | FPGReferenceDiscountedCareInd |
Discounted Care Oth Percentage DiscountedCareOthPercentageGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | Yes (X) | OtherInd |
| Discounted Care Other | 175.000000000000 | DiscountedCareOtherPct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Free Care Medically Indigent | Yes (1) | FreeCareMedicallyIndigentInd |
| Financial Assistance Budget | Yes (1) | FinancialAssistanceBudgetInd |
| Expenses Exceed Budget | 0 | ExpensesExceedBudgetInd |
| Annual Community Bnft Report | 0 | AnnualCommunityBnftReportInd |
Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $67,400 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $67,400 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00520 | TotalExpensePct |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $2,698,328 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $2,076,385 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $621,943 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.04770 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $2,765,728 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $2,076,385 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $689,343 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.05290 | TotalExpensePct |
Community Health Services CommunityHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $6,084 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $3,432 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $2,652 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00020 | TotalExpensePct |
Subsidized Health Services SubsidizedHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $2,032,438 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $865,748 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $1,166,690 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.08940 | TotalExpensePct |
Cash And In Kind Contributions CashAndInKindContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $1,100 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $1,100 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00010 | TotalExpensePct |
Total Other Benefits TotalOtherBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $2,039,622 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $869,180 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $1,170,442 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.08970 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $4,805,350 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $2,945,565 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $1,859,785 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.14260 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | 0 | BadDebtExpenseReportedInd |
| Bad Debt Expense | $409,163 | BadDebtExpenseAmt |
| Bad Debt Expense Attributable | $204,582 | BadDebtExpenseAttributableAmt |
| Reimbursed By Medicare | $3,363,684 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $3,437,276 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | -$73,592 | 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 | Yes (1) | WrittenDebtCollectionPolicyInd |
| Financial Assistance Prvsn | Yes (1) | FinancialAssistancePrvsnInd |
| 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 | Coteau des Prairies Hospital & Clinic | BusinessNameLine1 |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 205 Orchard Drive | AddressLine1 |
| City | Sisseton | City |
| State | SD | State |
| ZIP Code | 57262 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Website Address | www.cdphospital.com | WebsiteAddressTxt |
| State License | 60020 | StateLicenseNum |
| Licensed Hospital | Yes (X) | LicensedHospitalInd |
| General Medical And Surgical | Yes (X) | GeneralMedicalAndSurgicalInd |
| Critical Access Hospital | Yes (X) | CriticalAccessHospitalInd |
| Emergency Room24 Hrs | Yes (X) | EmergencyRoom24HrsInd |
| Other | 1 provider based rural health clinic | OtherDesc |
Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Coteau des Prairies Hospital & Clinic | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
| CHNA Conducted | Yes (1) | 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 |
| CHNA Conducted | 13 | CHNAConductedYr |
| Take Into Account Others Input | Yes (1) | TakeIntoAccountOthersInputInd |
| CHNA Conducted With Other Fclts | 0 | CHNAConductedWithOtherFcltsInd |
| CHNA Report Widely Available | Yes (1) | CHNAReportWidelyAvailableInd |
| Rpt Available On Own Website | Yes (X) | RptAvailableOnOwnWebsiteInd |
| Own Website URL | www.cdphospital.com | OwnWebsiteURLTxt |
| Rpt Available Upon Request | Yes (X) | RptAvailableUponRequestInd |
| Adopt Implementation Strategy | Yes (X) | AdoptImplementationStrategyInd |
| Exec Implementation Strategy | Yes (X) | ExecImplementationStrategyInd |
| Include Operational Plan | Yes (X) | IncludeOperationalPlanInd |
| Adopt Budget | Yes (X) | AdoptBudgetInd |
| Prioritize Health Needs | Yes (X) | PrioritizeHealthNeedsInd |
| Prioritize Services | Yes (X) | PrioritizeServicesInd |
| Other Needs Addressed | Yes (X) | OtherNeedsAddressedInd |
| All Needs Addressed | 0 | AllNeedsAddressedInd |
| Organization Incur Excise Tax | 0 | OrganizationIncurExciseTaxInd |
| Elig Criteria Explained | Yes (1) | EligCriteriaExplainedInd |
| FPG Used Deter Elig Free Care | Yes (1) | FPGUsedDeterEligFreeCareInd |
| FPG Family Incm Lmt Free Care | 150.000000000000 | FPGFamilyIncmLmtFreeCarePct |
| FPG Used Determ Elig Dscnt Care | Yes (1) | FPGUsedDetermEligDscntCareInd |
| FPG Family Incm Lmt Dscnt Care | 175.000000000000 | FPGFamilyIncmLmtDscntCarePct |
| Explained Basis | Yes (1) | ExplainedBasisInd |
| Income Level | Yes (X) | IncomeLevelInd |
| Asset Level | Yes (X) | AssetLevelInd |
| Medical Indigency | Yes (X) | MedicalIndigencyInd |
| Insurance Status | Yes (X) | InsuranceStatusInd |
| Medicaid Medicare | Yes (X) | MedicaidMedicareInd |
| App Financial Asst Expln | Yes (1) | AppFinancialAsstExplnInd |
| Includes Publicity Measures | Yes (1) | IncludesPublicityMeasuresInd |
| Available On Request | Yes (X) | AvailableOnRequestInd |
| Other Publicity | Yes (X) | OtherPublicityInd |
| FAP Actions On Nonpayment | Yes (1) | FAPActionsOnNonpaymentInd |
| Collection Activities | 0 | CollectionActivitiesInd |
| FAP Notified Upon Admission | Yes (X) | FAPNotifiedUponAdmissionInd |
| FAP Notified All Patients | Yes (X) | FAPNotifiedAllPatientsInd |
| Documented Elig Determination | Yes (X) | DocumentedEligDeterminationInd |
| Other Actions Taken | Yes (X) | OtherActionsTakenInd |
| Nondis Emergency Care Policy | Yes (1) | NondisEmergencyCarePolicyInd |
| Medicare Rates | Yes (X) | MedicareRatesInd |
| Amounts Generally Billed | 0 | AmountsGenerallyBilledInd |
| Gross Charges | 0 | GrossChargesInd |
Supplemental Information SupplementalInformationGrp (5 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Coteau des Prairies Hospital & Clinic | Part V, Section B, Line 3: The Hospital conducted community surveys online and in person, and an internal stake holder survey. There were also community and elite interviews with SWO, HIS, community leaders of service areas and emergency medical personnel, community members, and medical practitioners. |
| Coteau des Prairies Hospital & Clinic | Part V, Section B, Line 6i: Coteau des Prairies Hospital has adopted an implementation strategy to address the community health needs identified in its Community Health Needs Assessment. The implementation strategy is posted to the Hospital's website at www.cdphospital.com. |
| Coteau des Prairies Hospital & Clinic | Part V, Section B, Line 7: The following needs will not be addressed due to other organizations in the community addressing.1. Teen pregnancy/unsafe sex: Several key constituent groups within the community have established programs that address these issues.2. Affordable health care: Affordable health care is a national issue - one much larger than can be adequately addressed by a small, critical access hospital.3. Economic development/affordable housing: Activities are underway in the community that adequately address the need expressed by the community members throughout this assessment.A separate OB wing is in the process of completion at the end of 2013. |
| Coteau des Prairies Hospital & Clinic | Part V, Section B, Line 14g: A summary of the charity care policy is posted in the Hospital's main entrance/admission areas, the main entrance/admission areas for each of the clinics, and in the emergency rooms and waiting rooms. CDPH provides a copy of the policy, or a summary thereof, and financial assistance contact information to patients as part of the intake process, when applicable. In addition, CDPH personnel discuss with the patient the availability of various government benefits, such as Medicaid or state programs, and assist the patient with qualification for such programs, when applicable. |
| Coteau des Prairies Hospital & Clinic | Part V, Section B, Line 18e: Prior to initiating any collection actions listed in Schedule H, Part V, Line 17, patients were made aware of the financial assistance policy through signage in admissions and phone calls by Hospital staff prior to being sent to collection. Patient accounts were not sent to collection until patients were offered the financial assistance policy. |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 3 | FacilityNum |
Oth Hlth Care Fclts Not Hospital OthHlthCareFcltsNotHospitalGrp
Oth Hlth Care Fclts OthHlthCareFcltsGrp (3 entries)
| Address Line1USAddress/AddressLine1 | CityUSAddress/City | StateUSAddress/State | ZIP CodeUSAddress/ZIPCode | FacilityFacilityTxt |
|---|---|---|---|---|
| Browns Valley Clinic | ||||
| 106 4th Street South | Browns Valley | MN | 56219 | Family Practice Clinic |
| Rosholt Clinic | ||||
| 116 West Main Street | Rosholt | SD | 57260 | Family Practice Clinic |
| Herman Clinic | ||||
| 204 5th St East | Herman | MN | 56248 | Family Practice Clinic |
Supplemental Information Detail SupplementalInformationDetail (14 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Part I, Line 3c: | CDPH offers free care to patients with a family income not to exceed 150% of Federal Poverty Guidelines. In addition to the FPG test, for free and discounted care, CDPH also looks at the patient's asset values as well as their uninsured or underinsured insurance coverage status. For discounted care, CDPH patients will qualify with a family income not to exceed 175% of FPG. |
| 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. Unreimbursed Medicaid on line 7b was calculated using the costing methods to prepare the cost reports. Community health improvement services, line 7e and cash and in-kind donations, line 7i were compiled using actual costs and recorded in CBISA software. The cost for subsidized health services reported on line 7g was determined using the Medicare Cost Report. |
| Part I, Ln 7 Col(f): | Bad debt expense of $409,163 was subtracted from total operating expense. |
| Part II, Community Building Activities: | None |
| Part III, Line 2: | Bad debt write-offs are recorded using gross charges. When a payment is received or a discount is given on a bad debt account it offsets the current fiscal year bad debt expense. Bad debt expense on line 2 is reported at charges as presented on the financial statements. |
| Part III, Line 3: | Bad debt expense attributable to charity care is estimated based on income levels and ethnicity in this area. More than 50% of CDPH charges are generated by the Native American population. Statistics show the average household income of Native American families in Roberts County is two-thirds of that of other ethnic groups. Virtually all Native Americans qualify for charity care, thus the organization estimates approximately 50% of bad debt is attributable to persons who would qualify for charity care. |
| Part III, Line 4: | The footnote to the Organization's financial statements can be found on page 6 of the attached audited financial statements. |
| Part III, Line 8: | The Hospital provides services to Medicare patients knowing there could be a shortfall because access to healthcare and individual's health is important to the Hospital. Therefore, the Medicare shortfall is considered a community benefit.Total revenue received from Medicare (including DSH and IME) is the gross reimbursement plus settlement (including LSA). Both the total revenue received from Medicare and the Medicare allowable costs are reported from the Medicare Cost Report. The Medicare Cost Report is completed based on the rules and regulations set forth by Centers for Medicaid and Medicare Services. |
| Part III, Line 9b: | For patients who qualify for charity care and are cooperating in good faith to resolve their discounted hospital bills, Coteau des Prairies Hospital and Clinic may offer extended payment plans. The Hospital will not send unpaid bills to outside collection agencies and will cease all collection actions such as wage garnishments, liens on primary residences, or other legal actions. The Hospital will first make reasonable efforts to determine whether the patient is eligible for charity care under the financial assistance policy. |
| Part VI, Line 2: | The priority of CDPH is to promote the health of Sisseton and also the surrounding rural communities. During 2012, the Hospital began its efforts to conduct a community health needs assessment. Through this process, CDPH determined the health care needs of the community, and is working to ensure the services and events provided to the community are beneficial and in accordance with the community's health care needs. The Hospital finalized its CHNA and implementation strategy and made both documents widely available to the Public on December 04, 2013. |
| Part VI, Line 3: | CDPH utilizes multiple methods for patient education of financial assistance. A summary of the charity care policy is posted in the Hospital's main entrance/admission areas, the main entrance/admission areas for each of the clinics, and in the emergency rooms and waiting rooms. CDPH provides a copy of the policy, or a summary thereof, and financial assistance contact information to patients as part of the intake process, when applicable. In addition, CDPH personnel discuss with the patient the availability of various government benefits, such as Medicaid or state programs, and assist the patient with qualification for such programs, when applicable. |
| Part VI, Line 4: | CDP Hospital is located in Sisseton, a rural community in the northeast corner of South Dakota with the next closest healthcare facility being approximately 50 miles away. CDPH serves various ethnic groups. An Indian Health Services (IHS) clinic is located within 1 mile of the hospital. CDPH serves as the main emergency room for the IHS patients during office hours and after hours. The 2013 estimated population in Sisseton, SD was 2,470. Approximately 47% of the Sisseton area people are white, 47% are Native American, and 6% are two or more races.The estimated population in Roberts County, SD in 2013 was 10,149. Approximately 61% of Roberts County area people are white, 34% are native American, 3% are two or more races, and 1% claim Hispanic or Latino. |
| Part VI, Line 5: | CDPH is a sole community provider with a 12 member volunteer Board of Directors who all reside in the primary service area. Medical staff privileges are extended to all qualified individuals as they are requested. If CDPH were to have surplus funds, the funds would be applied to patient care improvements and also to reduce the need for rate increases for the patients. The emergency room is staffed 24 hours a day, 7 days a week and patients are welcomed regardless of race or the ability to pay for the services. CDPH participates in all government-sponsored health programs including Medicare, Medicaid, Indian Health Services, and Veteran Affairs benefits. The Hospital and clinics welcome students for training and college rotations in various healthcare professions. |
| Part VI, Line 6: | N/A |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Compensation Committee | Yes (X) | CompensationCommitteeInd |
| Written Employment Contract | Yes (X) | WrittenEmploymentContractInd |
| Board Or Committee Approval | Yes (X) | BoardOrCommitteeApprovalInd |
| Severance Payment | 0 | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | 0 | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | 0 | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | Yes (1) | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | 0 | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | 0 | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | 0 | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | 0 | AnyNonFixedPaymentsInd |
| Initial Contract Exception | 0 | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (5 entries)
| TitleTitleTxt | Base Compensation Filing OrgBaseCompensationFilingOrgAmt | Compensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmt | Bonus Filing OrganizationBonusFilingOrganizationAmount | Bonus Related OrganizationsBonusRelatedOrganizationsAmt | Other Compensation Filing OrgOtherCompensationFilingOrgAmt | Other Compensation Rltd OrgsOtherCompensationRltdOrgsAmt | Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt | Deferred Comp Rltd OrgsDeferredCompRltdOrgsAmt | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt | Nontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmt | Total Compensation Filing OrgTotalCompensationFilingOrgAmt | Total Compensation Rltd OrgsTotalCompensationRltdOrgsAmt | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmt | Comp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Dan Ellis | ||||||||||||||
| CEO | $129,540 | $0 | $0 | $0 | $0 | $0 | $4,082 | $0 | $16,765 | $0 | $150,387 | $0 | $0 | $0 |
| Stanley Gallagher DO | ||||||||||||||
| Osteopathy | $617,231 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $7,839 | $0 | $625,070 | $0 | $0 | $0 |
| Judy Beumer MD | ||||||||||||||
| OB GYN | $381,950 | $0 | $0 | $0 | $0 | $0 | $10,200 | $0 | $15,139 | $0 | $407,289 | $0 | $0 | $0 |
| David Staub MD | ||||||||||||||
| Family Practice | $411,063 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $7,649 | $0 | $418,712 | $0 | $0 | $0 |
| Linda Peterson MD FACOG | ||||||||||||||
| Family Practice | $167,292 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $7,106 | $0 | $174,398 | $0 | $0 | $0 |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | Part I, Line 5 | FormAndLineReferenceDesc |
| Explanation | Physicians are paid 38% of their respective provider/CPT code revenue. | ExplanationTxt |
Schedule K IRS990ScheduleK
Tax Exempt Bonds Issues TaxExemptBondsIssuesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
Issuer Name IssuerName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | City of Sisseton South Dakota | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Issuer EIN | 466000460 | BondIssuerEIN |
| Bond Issued | 2012-07-06 | BondIssuedDt |
| Issue Price | $7,450,000 | IssuePriceAmt |
| Purpose | Fund hospital remodeling and building addition project | PurposeDesc |
| Defeased | 0 | DefeasedInd |
| On Behalf Of Issuer | 0 | OnBehalfOfIssuerInd |
| Pool Financing | 0 | PoolFinancingInd |
Tax Exempt Bonds Proceeds TaxExemptBondsProceedsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Retired | $68,845 | RetiredAmt |
| Total Proceeds | $7,450,000 | TotalProceedsAmt |
| Capitalized Interest | $211,000 | CapitalizedInterestAmt |
| Issuance Costs From Proceeds | $122,280 | IssuanceCostsFromProceedsAmt |
| Working Capital Expenditures | $6,092,849 | WorkingCapitalExpendituresAmt |
| Capital Expenditures | $1,234,871 | CapitalExpendituresAmt |
| Current Refunding | 0 | CurrentRefundingInd |
| Advance Refunding | 0 | AdvanceRefundingInd |
| Final Allocation Made | 0 | FinalAllocationMadeInd |
| Adequate Books And Rec Maint | Yes (1) | AdequateBooksAndRecMaintInd |
Tax Exempt Bonds Private Bus Use TaxExemptBondsPrivateBusUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Owning Bond Financed Property | 0 | OwningBondFinancedPropertyInd |
| Any Lease Arrangements | 0 | AnyLeaseArrangementsInd |
| Mgmt Contract Bond Fincd Prop | 0 | MgmtContractBondFincdPropInd |
| Any Research Agreements | 0 | AnyResearchAgreementsInd |
| Private Bus Use By Others | 0.00000 | PrivateBusUseByOthersPct |
| Private Bus Concerning UBI | 0.00000 | PrivateBusConcerningUBIPct |
| Total Private Business Use | 0.00000 | TotalPrivateBusinessUsePct |
| Bond Iss Meet Prvt Sec Pymt Test | 0 | BondIssMeetPrvtSecPymtTestInd |
| Change In Use Bond Financed Prop | 0 | ChangeInUseBondFinancedPropInd |
| Procs Nonqualified Bond Remdtd | Yes (1) | ProcsNonqualifiedBondRemdtdInd |
Tax Exempt Bonds Arbitrage TaxExemptBondsArbitrageGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Form8038 T Filed | 0 | Form8038TFiledInd |
| Rebate Not Due Yet | 0 | RebateNotDueYetInd |
| Exception To Rebate | 0 | ExceptionToRebateInd |
| No Rebate Due | 0 | NoRebateDueInd |
| Variable Rate Issue | 0 | VariableRateIssueInd |
| Hedge Identified In Bks And Rec | 0 | HedgeIdentifiedInBksAndRecInd |
| Gross Proceeds Invested In GIC | 0 | GrossProceedsInvestedInGICInd |
| Gross Proceeds Invested | 0 | GrossProceedsInvestedInd |
| Written Proc To Monitor Reqs | Yes (1) | WrittenProcToMonitorReqsInd |
Procedures Corrective Action ProceduresCorrectiveActionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Procedures Corrective Action | Yes (1) | ProceduresCorrectiveActionInd |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (5 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Form 990, Part VI, Section A, line 1 | The Executive Committee consists of the President, Vice President, the Secretary, the Treasurer and one other member of the Board to be elected by the Board at the annual meeting. The Executive Committee has the power to transact all regular business of the hospital & clinic during the period between the meetings of the Board. Subject to any prior limitation imposed by the Board and with the understanding that all matters of major importance will be referred to the Board. Minutes of the Executive Committee meetings are available to the Board. |
| Form 990, Part VI, Section B, line 11 | The Board of Directors receives a copy of the Form 990 prior to filing. The Director of Finance reviews the 990 in detail. |
| Form 990, Part VI, Section B, line 12c | The conflict of interest policy is completed annually and covers officers and board members. The determination of whether a conflict exists is made at the Board of Directors level, as is the review of actual conflicts. Any person determined to have a conflict will have an opportunity to explain the situation, and he/she will be required to refrain from voting. |
| Form 990, Part VI, Section B, line 15 | Compensation for the CEO is determined through individual negotiations with the Executive Committee and the CEO. The Executive Committee uses salary surveys to determine what constitutes reasonable compensation. Negotiations with the Executive Committee include a performance evaluation. An evaluation is done annually by the Executive Committee, and approved by the Board of Directors. Compensation of CDPH's officers is determined through discussions between the Executive Committee and the CEO. The Executive Committee uses salary surveys to determine what constitutes reasonable compensation. Discussions with the Executive Committee include a performance evaluation. An evaluation is done annually by the Executive Committee, and approved by the Board of Directors. |
| Form 990, Part VI, Section C, line 19 | The governing documents, conflict of interest policy and financial statements are available upon request. |
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