ST MICHAELS HOSPITAL: Form 990, tax year 2011
View the entire original 990 at ProPublica ↗
- Organization
- ST MICHAELS HOSPITAL (EIN 46-0225414)
- Tax period
- 2011-07-01 to 2012-06-30
- Filed
- 2013-05-14
- IRS object ID
- 201311349349302266
- Schema version
- 2011v1.5
- 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 | 2013-05-14T10:19:09-05:00 | Timestamp |
| Tax Period End Date | 2012-06-30 | 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 | 2011-07-01 | TaxPeriodBeginDate |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 460225414 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | St Michael's Hospital Inc | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Control | STMI | NameControl |
| Phone | 6055893341 | Phone |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 410 West 16th Avenue | AddressLine1 |
| City | Tyndall | City |
| State | SD | State |
| ZIP Code | 570662318 | ZIPCode |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | Carol Deurmier | Name |
| Title | CEO | Title |
| Phone | 6055893341 | Phone |
| Date Signed | 2013-05-07 | 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 | 2013-05-07 | DatePrepared |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax Year | 2011 | TaxYear |
| Build TS | 2016-02-24 21:20:13Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Principal Officer Person | Carol Deurmier | NameOfPrincipalOfficerPerson |
Address Principal Officer US AddressPrincipalOfficerUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 410 West 16th Avenue | AddressLine1 |
| City | Tyndall | City |
| State | SD | State |
| ZIP Code | 570662318 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | 8627115 | GrossReceipts |
| Group Return For Affiliates | 0 | GroupReturnForAffiliates |
| Group Exemption Number | 0928 | GroupExemptionNumber |
| Organization501c3 | X | Organization501c3 |
| Web Site | www.avera.org/ash/stmichaels | WebSite |
| Type Of Organization Corporation | X | TypeOfOrganizationCorporation |
| Year Formation | 1966 | YearFormation |
| State Legal Domicile | SD | StateLegalDomicile |
| Activity Or Mission Description | To provide healthcare services. | ActivityOrMissionDescription |
| Nbr Voting Members Governing Body | 7 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 7 | NbrIndependentVotingMembers |
| Total Nbr Employees | 96 | TotalNbrEmployees |
| Total Nbr Volunteers | 63 | TotalNbrVolunteers |
| Total Gross UBI | 268056 | TotalGrossUBI |
| Net Unrelated Business Txbl Income | -66175 | NetUnrelatedBusinessTxblIncome |
| Contributions Grants Prior Year | 26224 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 55105 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 8156936 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 8503622 | ProgramServiceRevenueCY |
| Investment Income Prior Year | 69866 | InvestmentIncomePriorYear |
| Investment Income Current Year | 61337 | InvestmentIncomeCurrentYear |
| Other Revenue Prior Year | -6095 | OtherRevenuePriorYear |
| Other Revenue Current Year | -2926 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 8246931 | TotalRevenuePriorYear |
| Total Revenue Current Year | 8617138 | 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 | 3746458 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 3984020 | 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 | 4121466 | OtherExpensePriorYear |
| Other Expenses Current Year | 4195902 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 7867924 | TotalExpensesPriorYear |
| Total Expenses Current Year | 8179922 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | 379007 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | 437216 | RevenuesLessExpensesCY |
| Total Assets BOY | 8194262 | TotalAssetsBOY |
| Total Assets EOY | 8178739 | TotalAssetsEOY |
| Total Liabilities BOY | 1729418 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 1343319 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | 6464844 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 6835420 | NetAssetsOrFundBalancesEOY |
| Info In Schedule O Part III | X | InfoInScheduleOPartIII |
| Mission Description | It is the mission of St. Michael's Hospital to provide readily accessible health care to the people of Bon Homme County and the surrounding areas. In keeping with the heritage of the Catholic Church, St. Michael's will aim to promote the physical, mental, social and spiritual health of all its patients and residents. The health care centers will continue to offer quality services based on community needs and fiscal solvency. | MissionDescription |
| Significant New Program Services | 0 | SignificantNewProgramServices |
| Significant Change | 0 | SignificantChange |
| Expense | 7273122 | Expense |
| Revenue | 8235566 | Revenue |
| Description | St. Michael's Hospital, Inc. (SMH) operates a 25-bed critical access hospital with provider based rural health clinics located in Tyndall and in Avon. Provider staff, nursing personnel, laboratory and radiology personnel are available as needed 24-hours a day, 7-days a week. During the fiscal year ending June 30, 2012, patient days were 314 and swing-bed days were 2,857. | Description |
| Total Program Service Expense | 7273122 | 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 | 1 | TermOrPermanentEndowments |
| Report Land Bldg Equip | 1 | ReportLandBldgEquip |
| Report Invest Oth Securities | 1 | ReportInvestOthSecurities |
| Report Prog Rel Invest | 0 | ReportProgRelInvest |
| Report Other Assets | 0 | ReportOtherAssets |
| Report Other Liabilities | 0 | 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 | 0 | TaxExemptBonds |
| 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 |
| Transaction Related Entity | 0 | TransactionRelatedEntity |
| Transfers To Exempt Non Chrtbl Org | 0 | TransfersToExemptNonChrtblOrg |
| Activities Conducted Partnership | 0 | ActivitiesConductedPartnership |
| Schedule O Required | 1 | ScheduleORequired |
| Number Forms Transmitted With1096 | 17 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Compliance With Backup Witholding | 1 | ComplianceWithBackupWitholding |
| Number Of Employees | 96 | NumberOfEmployees |
| Employment Tax Returns Filed | 1 | EmploymentTaxReturnsFiled |
| Unrelated Business Income | 1 | UnrelatedBusinessIncome |
| Form990-T Filed | 1 | Form990-TFiled |
| 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 | 7 | NbrVotingGoverningBodyMembers |
| Number Independent Voting Members | 7 | 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 | 0 | MembersOrStockholders |
| Election Of Board Members | 0 | 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 | 1 | 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 | Lisa Ronke | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Telephone Number | 6055893341 | TelephoneNumber |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 410 W 16th Ave | AddressLine1 |
| City | Tyndall | City |
| State | SD | State |
| ZIP Code | 570662318 | ZIPCode |
Form990 Part VII Section A Form990PartVIISectionA (12 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 |
|---|---|---|---|---|---|---|---|
| Russell Bechtold | |||||||
| Chairperson | 1.00 | X | X | 0 | 0 | 0 | |
| Jim Stoebner | |||||||
| Vice Chairperson | 1.00 | X | X | 0 | 0 | 0 | |
| Marlene Zieser-Blackburn | |||||||
| Secretary | 1.00 | X | X | 0 | 0 | 0 | |
| Sister Paulette Larsen | |||||||
| Member | 1.00 | X | 0 | 0 | 0 | ||
| Marty Koch | |||||||
| Member | 1.00 | X | 0 | 0 | 0 | ||
| Don Irish | |||||||
| Member | 1.00 | X | 0 | 0 | 0 | ||
| Father Joe Forcelle | |||||||
| Member | 1.00 | X | 0 | 0 | 0 | ||
| Carol Deurmier | |||||||
| CEO | 50.00 | X | 120275 | 0 | 22872 | ||
| Lisa Ronke | |||||||
| Director of Finance | 40.00 | X | 37629 | 0 | 15396 | ||
| Dr Melvin Wallinga | |||||||
| Physician | 40.00 | 166090 | 0 | 20507 | X | ||
| Dr Jill Kruse | |||||||
| Physician | 40.00 | 197596 | 0 | 21792 | X | ||
| Jaclyn Dvoracek | |||||||
| Pharmacy Director | 37.00 | 106333 | 0 | 19451 | X | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 627923 | TotalReportableCompFromOrg |
| Total Reportable Comp Frm Rltd Orgs | 0 | TotalReportableCompFrmRltdOrgs |
| Total Other Compensation | 100018 | TotalOtherCompensation |
| Number Individuals GT100 K | 4 | NumberIndividualsGT100K |
| Formers Listed | 0 | FormersListed |
| Total Comp GT150 K | 1 | TotalCompGT150K |
| Compensation From Other Sources | 1 | CompensationFromOtherSources |
Contractor Compensation ContractorCompensation
Name Of Contractor NameOfContractor
Name Business NameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Avera Sacred Heart Hospital | BusinessNameLine1 |
Address Of Contractor AddressOfContractor
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 501 Summit | AddressLine1 |
| City | Yankton | City |
| State | SD | State |
| ZIP Code | 57078 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description Of Services | Management, Occupational&Speech Therapy, | DescriptionOfServices |
| Compensation | 585136 | Compensation |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Contractors GT100 K | 1 | NumberOfContractorsGT100K |
| Government Grants | 28781 | GovernmentGrants |
| All Other Contributions | 26324 | AllOtherContributions |
| Total Contributions | 55105 | TotalContributions |
Program Service Revenue ProgramServiceRevenue (3 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome | Unrelated Business RevenueUnrelatedBusinessRevenue |
|---|---|---|---|---|
| Patient Service Fees | 621110 | 6198982 | 6198982 | |
| Retail Pharmacy | 446110 | 2257006 | 1988950 | 268056 |
| Miscellaneous | 900099 | 47634 | 47634 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | 8503622 | TotalProgramServiceRevenue |
Investment Income InvestmentIncome
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 60780 | TotalRevenueColumn |
| Exclusion | $60,780 | ExclusionAmount |
Gross Rents GrossRents
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 7051 | Real |
Less Rental Expenses LessRentalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 9977 | Real |
Rental Income Or Loss RentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | -2926 | Real |
Net Rental Income Or Loss NetRentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -2926 | TotalRevenueColumn |
| Exclusion | -$2,926 | ExclusionAmount |
Gross Amount Sales Assets GrossAmountSalesAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | 557 | Other |
Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | 0 | Other |
Gain Or Loss GainOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | 557 | Other |
Net Gain Or Loss Investments NetGainOrLossInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 557 | TotalRevenueColumn |
| Exclusion | $557 | ExclusionAmount |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 8617138 | TotalRevenueColumn |
| Related Or Exempt Function Income | 8235566 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 268056 | UnrelatedBusinessRevenue |
| Exclusion | $58,411 | ExclusionAmount |
Comp Current Officers Directors CompCurrentOfficersDirectors
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 199298 | Total |
| Management And General | 199298 | ManagementAndGeneral |
Other Salaries And Wages OtherSalariesAndWages
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 3198737 | Total |
| Program Services | 2932276 | ProgramServices |
| Management And General | 266461 | ManagementAndGeneral |
Pension Plan Contributions PensionPlanContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 105599 | Total |
| Program Services | 97098 | ProgramServices |
| Management And General | 8501 | ManagementAndGeneral |
Other Employee Benefits OtherEmployeeBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 260643 | Total |
| Program Services | 239406 | ProgramServices |
| Management And General | 21237 | ManagementAndGeneral |
Payroll Taxes PayrollTaxes
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 219743 | Total |
| Program Services | 198529 | ProgramServices |
| Management And General | 21214 | ManagementAndGeneral |
Fees For Services Management FeesForServicesManagement
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 115722 | Total |
| Management And General | 115722 | ManagementAndGeneral |
Fees For Services Accounting FeesForServicesAccounting
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 33375 | Total |
| Management And General | 33375 | ManagementAndGeneral |
Fees For Services Other FeesForServicesOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 131063 | Total |
| Program Services | 124183 | ProgramServices |
| Management And General | 6880 | ManagementAndGeneral |
Advertising Advertising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 6980 | Total |
| Program Services | 2345 | ProgramServices |
| Management And General | 4635 | ManagementAndGeneral |
Office Expenses OfficeExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 130150 | Total |
| Program Services | 68624 | ProgramServices |
| Management And General | 61526 | ManagementAndGeneral |
Information Technology InformationTechnology
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 112994 | Total |
| Management And General | 112994 | ManagementAndGeneral |
Occupancy Occupancy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 113092 | Total |
| Program Services | 113057 | ProgramServices |
| Management And General | 35 | ManagementAndGeneral |
Travel Travel
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 16244 | Total |
| Program Services | 10201 | ProgramServices |
| Management And General | 6043 | ManagementAndGeneral |
Conferences Meetings ConferencesMeetings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 5345 | Total |
| Program Services | 4735 | ProgramServices |
| Management And General | 610 | ManagementAndGeneral |
Interest Interest
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 44798 | Total |
| Program Services | 44798 | ProgramServices |
Depreciation Depletion DepreciationDepletion
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 451562 | Total |
| Program Services | 451562 | ProgramServices |
Insurance Insurance
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 72472 | Total |
| Program Services | 72472 | ProgramServices |
Other Expenses OtherExpenses (4 entries)
| DescriptionDescription | TotalTotal | Program ServicesProgramServices | Management And GeneralManagementAndGeneral |
|---|---|---|---|
| Medical Supplies | 2555098 | 2555098 | |
| Equipment & Maintenance | 263975 | 231857 | 32118 |
| Bad Debt | 88787 | 88787 | |
| Dues and Subscriptions | 34158 | 18064 | 16094 |
All Other Expenses AllOtherExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 20087 | Total |
| Program Services | 20030 | ProgramServices |
| Management And General | 57 | ManagementAndGeneral |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 8179922 | Total |
| Program Services | 7273122 | ProgramServices |
| Management And General | 906800 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Savings And Temp Cash Investments SavingsAndTempCashInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1465504 | BOY |
| EOY | 1749703 | EOY |
Accounts Receivable AccountsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 762484 | BOY |
| EOY | 810451 | EOY |
Receivables From Officers Etc ReceivablesFromOfficersEtc
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 26172 | BOY |
| EOY | 0 | EOY |
Inventories For Sale Or Use InventoriesForSaleOrUse
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 409483 | BOY |
| EOY | 379189 | EOY |
Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 32121 | BOY |
| EOY | 56129 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Buildings Equipment Basis | 7560072 | LandBuildingsEquipmentBasis |
| Land Bldg Equipment Accum Deprec | 4485137 | LandBldgEquipmentAccumDeprec |
Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 3369301 | BOY |
| EOY | 3074935 | EOY |
Investments Pub Traded Securities InvestmentsPubTradedSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 841735 | BOY |
| EOY | 833858 | EOY |
Investments Other Securities InvestmentsOtherSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1262940 | BOY |
| EOY | 1252809 | EOY |
Other Assets Total OtherAssetsTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 24522 | BOY |
| EOY | 21665 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 8194262 | BOY |
| EOY | 8178739 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 878481 | BOY |
| EOY | 560561 | EOY |
Deferred Revenue DeferredRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 237 | BOY |
| EOY | 11822 | EOY |
Tax Exempt Bond Liabilities TaxExemptBondLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 850700 | BOY |
| EOY | 770936 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1729418 | BOY |
| EOY | 1343319 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Unrestricted Net Assets UnrestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 6433186 | BOY |
| EOY | 6803783 | EOY |
Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 12020 | BOY |
| EOY | 11739 | EOY |
Permanently Restricted Net Assets PermanentlyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 19638 | BOY |
| EOY | 19898 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 6464844 | BOY |
| EOY | 6835420 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 8194262 | BOY |
| EOY | 8178739 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | X | InfoInScheduleOPartXI |
| Reconcilation Revenue Expenses | 437216 | ReconcilationRevenueExpenses |
| Reconcilation Other Changes | -66640 | ReconcilationOtherChanges |
| Method Of Accounting Accrual | X | MethodOfAccountingAccrual |
| Accountant Compile Or Review | 0 | AccountantCompileOrReview |
| FS Audited | 1 | FSAudited |
| Audit Committee | 0 | AuditCommittee |
| Financial Statement Separate | X | FinancialStatementSeparate |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequired |
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
Current Year CurrentYear
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Of Year Balance | 19638 | BeginningOfYearBalance |
| Contributions | 260 | Contributions |
| End Of Year Balance | 19898 | EndOfYearBalance |
Current Year Minus1 Year CurrentYearMinus1Year
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Of Year Balance | 19378 | BeginningOfYearBalance |
| Contributions | 260 | Contributions |
| End Of Year Balance | 19638 | EndOfYearBalance |
Current Year Minus2 Years CurrentYearMinus2Years
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Of Year Balance | 19138 | BeginningOfYearBalance |
| Contributions | 240 | Contributions |
| End Of Year Balance | 19378 | EndOfYearBalance |
Current Year Minus3 Years CurrentYearMinus3Years
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Of Year Balance | 18878 | BeginningOfYearBalance |
| Contributions | 260 | Contributions |
| End Of Year Balance | 19138 | EndOfYearBalance |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Permanent Endowment EOY Balance | 1.00000 | PermanentEndowmentEOYBalance |
| Endowments Held By Unrelated Orgs | 0 | EndowmentsHeldByUnrelatedOrgs |
| Endowments Held By Related Orgs | 0 | EndowmentsHeldByRelatedOrgs |
Land Land
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 92059 | OtherCostOrOtherBasis |
| Book Value | 92059 | BookValue |
Buildings Buildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 3519356 | OtherCostOrOtherBasis |
| Depreciation | 1866354 | Depreciation |
| Book Value | 1653002 | BookValue |
Equipment Equipment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 3848130 | OtherCostOrOtherBasis |
| Depreciation | 2561184 | Depreciation |
| Book Value | 1286946 | BookValue |
Other Land Buildings OtherLandBuildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 100527 | OtherCostOrOtherBasis |
| Depreciation | 57599 | Depreciation |
| Book Value | 42928 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Land Buildings | 3074935 | TotalOfBookValueLandBuildings |
Other Securities OtherSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | Interest in Avera Pooled Investment Funds | Description |
| Book Value | 1252809 | BookValue |
| Method Of Valuation | F | MethodOfValuation |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Securities | 1252809 | TotalOfBookValueSecurities |
| Total Revenue | 8617138 | TotalRevenue |
| Total Expenses | 8179922 | TotalExpenses |
| Excess Or Deficit For Year | 437216 | ExcessOrDeficitForYear |
| Net Unrealized GL On Investments | -66640 | NetUnrealizedGLOnInvestments |
| Total Adjustments | -66640 | TotalAdjustments |
| Excess Or Deficit Per FS | 370576 | ExcessOrDeficitPerFS |
| Tot Revenue Etc Audited Fincl Stmt | 8461711 | TotRevenueEtcAuditedFinclStmt |
| Net Unrealized Gains Investments | -66640 | NetUnrealizedGainsInvestments |
| Revenue Not Rptd F990 | -66640 | RevenueNotRptdF990 |
| Revenue Subtotal | 8528351 | RevenueSubtotal |
| Other Revenues Not Included | 88787 | OtherRevenuesNotIncluded |
| Revenue Not Rptd On Fin Stmt | 88787 | RevenueNotRptdOnFinStmt |
| Total Revenue Per Form990 | 8617138 | TotalRevenuePerForm990 |
| Tot Expenses Etc Audited Fincl Stmt | 8091135 | TotExpensesEtcAuditedFinclStmt |
| Expenses Not Rptd F990 | 0 | ExpensesNotRptdF990 |
| Expenses Subtotal | 8091135 | ExpensesSubtotal |
| Other Expenses Not Included | 88787 | OtherExpensesNotIncluded |
| Expenses Not Rptd On Fin Stmt | 88787 | ExpensesNotRptdOnFinStmt |
| Total Expenses Per Form990 | 8179922 | TotalExpensesPerForm990 |
Form990 Schedule D Part XIV Form990ScheduleDPartXIV (4 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| Description of Intended Use of Endowment Funds: | Part V, Line 4: | The intended use of the organization's endowment funds is to provide for capital needs that may arise. |
| Description of Uncertain Tax Positions Under FIN 48: | Part X: | 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. The Hospital's federal Form 990T filings are no longer subject to federal tax examinations by tax authorities for years before 2009. |
| Part XII, Line 4b - Other Adjustments: | Bad Debt Expense 88,787. | |
| Part XIII, Line 4b - Other Adjustments: | Bad Debt Expense 88,787. |
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 | 1 | FPGReferenceFreeCare |
| Pcent100 | X | Pcent100 |
| FPG Reference Discounted Care | 1 | FPGReferenceDiscountedCare |
Discounted Other DiscountedOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | X | Other |
| Discounted Other Percentage | 150.000000000000 | DiscountedOtherPercentage |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Free Disc Care Medically Indigent | 1 | FreeDiscCareMedicallyIndigent |
| Amounts Budgeted For Charity Care | 0 | AmountsBudgetedForCharityCare |
| Annual Community Benefit Report | 1 | AnnualCommunityBenefitReport |
| Report Publically Available | 1 | ReportPublicallyAvailable |
Charity Care At Cost CharityCareAtCost
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 49000 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 49000 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00610 | PercentOfTotalExpense |
Unreimbursed Medicaid UnreimbursedMedicaid
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 249627 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 227920 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 21707 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00270 | PercentOfTotalExpense |
Total Charity Care TotalCharityCare
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 298627 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 227920 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 70707 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00880 | PercentOfTotalExpense |
Community Health Services CommunityHealthServices
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 136589 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 6407 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 130182 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.01610 | PercentOfTotalExpense |
Health Professions Education HealthProfessionsEducation
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 26502 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 934 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 25568 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00320 | PercentOfTotalExpense |
Subsidized Health Services SubsidizedHealthServices
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 1367179 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 704193 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 662986 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.08190 | PercentOfTotalExpense |
Cash And In Kind Contributions CashAndInKindContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 8849 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 8849 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00110 | PercentOfTotalExpense |
Total Other Benefits TotalOtherBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 1539119 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 711534 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 827585 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.10230 | PercentOfTotalExpense |
Total Community Benefits TotalCommunityBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 1837746 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 939454 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 898292 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.11110 | PercentOfTotalExpense |
Economic Development EconomicDevelopment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Building Expense | 538 | TotalCommunityBuildingExpense |
| Net Community Building Expense | 538 | NetCommunityBuildingExpense |
| Percent Of Total Expense | 0.00010 | PercentOfTotalExpense |
Workforce Development WorkforceDevelopment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Building Expense | 277 | TotalCommunityBuildingExpense |
| Net Community Building Expense | 277 | NetCommunityBuildingExpense |
| Percent Of Total Expense | 0.00000 | PercentOfTotalExpense |
Total Total
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Building Expense | 815 | TotalCommunityBuildingExpense |
| Net Community Building Expense | 815 | NetCommunityBuildingExpense |
| Percent Of Total Expense | 0.00010 | PercentOfTotalExpense |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | 0 | BadDebtExpenseReported |
| Bad Debt Expense | $88,787 | BadDebtExpenseAmount |
| Amount Attributable To | 31075 | AmountAttributableTo |
| Amount Reimbursed By Medicare | 2874492 | AmountReimbursedByMedicare |
| Cost Of Care Reimbursed By Medicare | 2846031 | CostOfCareReimbursedByMedicare |
| Medicare Surplus Or Shortfall | 28461 | 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 | St Michael's Hospital Inc | BusinessNameLine1 |
Address Address
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 410 West 16th Avenue | AddressLine1 |
| City | Tyndall | City |
| State | SD | State |
| ZIP Code | 570660027 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| 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 | St Michael's Hospital Inc | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital Facility Number | 1 | HospitalFacilityNumber |
| CHNA Conducted | 0 | CHNAConducted |
| Eligibility Criteria Explained | 1 | EligibilityCriteriaExplained |
| Uses FPG Free | 1 | UsesFPGFree |
| FPG Free Percent | 100.000000000000 | FPGFreePercent |
| Uses FPG Discounted | 1 | UsesFPGDiscounted |
| FPG Discount Percent | 150.000000000000 | FPGDiscountPercent |
| Explains Basis | 0 | ExplainsBasis |
| Explains Application Method | 1 | ExplainsApplicationMethod |
| Includes Publicity Measures | 1 | IncludesPublicityMeasures |
| Available On Request | X | AvailableOnRequest |
| Other Publicity | X | OtherPublicity |
| Actions On Nonpayment | 1 | ActionsOnNonpayment |
| Collection Activities | 0 | CollectionActivities |
| Nondiscrim Emergency Care Policy | 1 | NondiscrimEmergencyCarePolicy |
| Used Other Method | X | UsedOtherMethod |
| Amounts Generally Billed | 0 | AmountsGenerallyBilled |
| Gross Charges | 1 | GrossCharges |
Form990 Schedule H Part V Section C Form990ScheduleHPartVSectionC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Other Facilities | 3 | NumberOfOtherFacilities |
Other Facilities OtherFacilities (3 entries)
| Address Line1Address/AddressLine1 | CityAddress/City | StateAddress/State | ZIP CodeAddress/ZIPCode | Facility TypeFacilityType |
|---|---|---|---|---|
| St Michaels Hospital Inc | ||||
| 410 West 16th Avenue | Tyndall | SD | 57066 | Wellness Center |
| Bon Homme Family Practice Clinic | ||||
| 130 Main Street | Avon | SD | 57315 | Family Practice Clinic |
| Bon Homme Family Practice Clinic | ||||
| 410 West 16th Avenue | Tyndall | SD | 57066 | Family Practice Clinic |
Form990 Schedule H Part VI Form990ScheduleHPartVI (17 entries)
| ExplanationExplanation | IdentifierIdentifier |
|---|---|
| Part I, Line 3c: In addition to the use of FPG to determine eligibility for free or discounted care, SMH also looks at the patient's assets, liabilities, outstanding medical debts and the overall debt to asset ratio for each situation. Being in a rural community with a small population, SMH may also use known information of a patient's hardships in making the final determination. | |
| Part I, Line 6a: SMH prepares a community benefit report that is submitted to Avera Health. The information is made available to the public through Avera Health's community benefit report. | |
| 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. Lines 7e, 7f, and 7i were obtained utilizing the actual general ledger system. Lines 7b and 7g were obtained from the Medicare cost report. | |
| Part I, L7 Col(f): Bad debt expense of $88,787 was subtracted from total operating expense. | |
| Part II: SMH is involved with the area Chamber of Commerce and Rotary Club. SMH works to enhance the quality of life and empower its patients, care-givers and community with the resources they need when they need them. SMH also provides healthcare career education to promote healthcare careers and rural health. | |
| Part III, Line 4: a) The amount on line 3 of $31,075 is 35% of total bad debt expense. The number is based on a detailed review of the accounts that are currently listed with Credit Collection Bureau and Accounts Management. Upon reviewing each account that is at CCB and AMI, it was found that about 35% of the outstanding balances may have been eligible under the facility's charity care policy. Since we are a small community, we were able to identify which accounts may have qualified for charity care because of low income or some known hardship to the household. Also for this review process, any families with prior applications for charity care were given consideration when reviewing the CCB and AMI accounts. b) Bad debt expense is made up of the actual accounts that are written off during the year as well as a change in the estimate for patient accounts that are still outstanding on the books and records of the facility. Bad debt recoveries are posted as a reduction to bad debt expense.c) Footnote From Financial Statement: Patient accounts receivable are reduced by an allowance for doubtful accounts. In evaluating the collectability of accounts receivable, the Hospital analyzes its past history and identifies trends for each of its major payor sources of revenue to estimate the appropriate allowance for doubtful accounts and provision for bad debts. Management regularly reviews data about these major payor sources of revenue in evaluating the sufficiency of the allowance for doubtful accounts. For receivables associated with services provided to patients who have third party coverage, the Hospital analyzes contractually due amounts and provides an allowance for doubtful accounts and a provision for bad debts, if necessary (for example, for expected uncollectible deductibles and copayments on accounts for which the third-party payor has not yet paid, or for payors who are known to be having financial difficulties that make the realization of amounts due unlikely). For receivables associated with self-pay patients (which includes both patients without insurance and patients with deductible and copayment balances due for which third-party coverage exists for part of the bill), the Hospital records a significant provision for bad debts in the period of service on the basis of its past experience, which indicates that many patients are unable or unwilling to pay the portion of their bill for which they are financially responsible. The difference between the standard rates (or the discounted rates, if negotiated) and the amounts actually collected after all reasonable collection efforts have been exhausted is charged off against the allowance for doubtful accounts. | |
| Part III, Line 8: Medicare allowable cost of care was calculated from the medicare cost report for the fiscal year ending 6/30/2012. | |
| Part III, Line 9b: SMH provides care to patients who meet certain criteria under its charity care policy without charge or at amounts less than its established rates. The Hospital does not pursue collections of amounts determined to qualify as charity care. | |
| Part V, Section B, Line 13g: Staff discuss the availability of its charity care policy with patients upon admission. Notice is also included in payment reminder letters. | St. Michael's Hospital, Inc. |
| Part V, Section B, Line 19d: All patients are charged gross charges initially. As of year end, a policy had not been approved by management to determine the amounts generally billed discount under the Prospective or Look-back Method.The Hospital is in the process of updating policies and procedures to meet the provisions of the new 501(r). They will be using the proposed regulations as a guideline for making changes to current policies. | St. Michael's Hospital, Inc. |
| Part V, Section B, Line 20: The Hospital is in the process of updating policies and procedures to meet the provisions of the new 501(r). They will be using the proposed regulations as a guideline for making changes to current policies. | St. Michael's Hospital, Inc. |
| Part V, Section B, Line 21: The Hospital is in the process of updating policies and procedures to meet the provisions of the new 501(r). They will be using the proposed regulations as a guideline for making changes to current policies. | St. Michael's Hospital, Inc. |
| Part VI, Line 2: The South Dakota Department of Health's Rural Health office conducted a Community Assessment for Bon Homme County with a special focus on the needs of the communities of Tyndall and Avon. SMH utilized this data in determining services needed.The Community Assessment compiled by the South Dakota Office of Rural Health for Bon Homme County identified a high health status indicator for diabetes mellitus (41.6 compared to 25.0 in the entire state of South Dakota and 24.4 in the United States). SMH has established a diabetes education program that has been awarded Education Recognition by the American Diabetes Association. This education is provided by an interdisciplinary team which includes a dietitian and nurses with specialized training. The program is available to all persons, and is designed to provide a benefit to the community.The Medical Staff of SMH, in working with the activity directors and coaching staffs of our local schools, also identified a concern for safety for athletes who have suffered a concussion and the need for a consistent process to determine when it is safe for the child to resume participation. In response to that need, SMH now provides an Impact program to high school students who participate in athletic programs in Tyndall and in Avon. The Impact program is funded totally by SMH and is provided free of charge to the students. It provides a baseline which can be used to assist in the determination for safe return to play after a concussion occurs. | |
| Part VI, Line 3: The SMH staff assists patients who may be eligible for financial assistance by discussing the availability of various government benefits, such as Medicaid or state programs, and assisting the patient with qualification for such programs where applicable. The programs are discussed at the time of admission and by patient request. Posters highlighting various assistance options (i.e. All Women Count) are posted in the admission area. SMH staff also discuss the availability of its charity care policy with patients upon admission. | |
| Part VI, Line 4: SMH serves a rural population in Bon Homme County which includes the cities of Tyndall, Avon, Tabor, and Springfield. There is one other hospital in Bon Homme County located in Scotland.The 2011 census for Bon Homme County reported 6,983 people with 12.1% of the population at 100% poverty or below. 19% of Bon Homme County's population is age 65 or older (compared to 14.4% in the state of South Dakota). | |
| Part VI, Line 5: The majority of SMH's governing body is comprised of persons who reside in Bon Homme County who are neither employees nor contractors of the organization, nor family members thereof. The organization extends medical staff privileges to all qualified physicians in its community for some or all of its departments. SMH applies surplus funds to improvements in patient care and provides readily accessible health care to the people of Bon Homme County and the surrounding area.SMH provides a variety of community benefit health activities at no cost or less than cost. These activities include wellness programs, diabetes education, foot clinics, CPR classes, and blood pressure screenings. A variety of programs are provided at no charge for the children in our communities such as the Impact concussion program, flu shot clinics, and athletic screenings. SMH also provides athletic physicals for students at a discounted rate. SMH provides a nurse on an as needed basis for ambulance transfers at no cost to the local ambulance service. Approximately 2,016 clients were served during the fiscal year ended 6/30/2012. SMH provided financial and in kind donations for various community needs such as meeting room availability, medical staff coverage at local sporting events, supplies for local blood drive and health education, along with Health Profession education for nursing and physical therapy students.SMH provides emergency services 24-hours a day, 7-days a week. In addition to nursing staff, a midlevel provider and/or physician are in house or on call at all times to provide care to anyone presenting with an emergent condition, regardless of their ability to pay. For fiscal year ended 6/30/2012, there were 586 patients who received emergency care at SMH.SMH has also made available e-Emergency services through an arrangement with Avera Health whereby emergency physicians and other specialists are available via videoconferencing to assist the medical staff and nurses with patients presenting to the SMH emergency room. The e-Emergency services are provided at no cost to the patient. 80 patients benefited from the e-Emergency services during fiscal year ended 6/30/2012. | |
| Part VI, Line 6: SMH is a managed facility of Avera Health. Avera Health and the Hospital work cooperatively to enhance healthcare throughout the community served by the Hospital. As a managed facility, SMH is able to participate in Avera e-CARE services. These services include Avera e-ICU, e-Emergency, e-Pharmacy and e-Consult. These services allow rural patients to be cared for at their local hospitals, provide rural hospitals access to immediate specialty care and support, and help reduce health care costs and travel.SMH also has access to "back office" support services, such as legal consultation, quality benchmarking, coding, computer services, contract negotiations, administrative consultation, group purchasing, human resource assistance and many other services. Avera Health is able to provide these services to SMH at a cost below that which the Hospital could otherwise achieve. In turn, local caregivers are able to devote more resources to patient and resident care. Avera Health and SMH dedicate resources to endeavors that make a positive difference to improve the health of the communities they serve. These activities include leadership development and training for community members, economic development, physical improvements in the community, contributions to nonprofit community organizations, nonprofit event sponsorships, donated medical supplies, community health education and support groups, health screenings, flu-shot clinics, community health education and various other activities. |
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 | 1 | 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 | 0 | AnyNonFixedPayments |
| Initial Contract Exception | 0 | InitialContractException |
Form990 Schedule J Part II Form990ScheduleJPartII (3 entries)
| 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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Carol Deurmier | |||||||||||||
| 119311 | 0 | 0 | 0 | 964 | 0 | 5383 | 0 | 17489 | 0 | 143147 | 0 | 0 | 0 |
| Dr Melvin Wallinga | |||||||||||||
| 165316 | 0 | 0 | 0 | 774 | 0 | 6985 | 0 | 13522 | 0 | 186597 | 0 | 0 | 0 |
| Dr Jill Kruse | |||||||||||||
| 164330 | 0 | 0 | 0 | 33266 | 0 | 8271 | 0 | 13522 | 0 | 219389 | 0 | 0 | 0 |
Form990 Schedule J Part III Form990ScheduleJPartIII (2 entries)
| Return ReferenceReturnReference | ExplanationExplanation | IdentifierIdentifier |
|---|---|---|
| Part I, Line 5 | Dr. Wallinga is paid based on production. | |
| Part III | Form 990, Part VII, Section A, Line 5 & Form 990, Schedule J, Part II: Carol Deurmier, CEO, is compensated by Avera Sacred Heart Hospital, 501 Summit, Yankton, SD 57078. | Supplemental Information |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (7 entries)
| Return ReferenceReturnReference | ExplanationExplanation | IdentifierIdentifier |
|---|---|---|
| Form 990, Part VI, Section A, line 3 | St. Michael's Hospital has a Partners in Health management agreement with Avera Sacred Heart Hospital. | |
| Form 990, Part VI, Section A, line 8b | The Board of Director committees are advisory in nature only and do not have authority to act on behalf of the governing body. | |
| Form 990, Part VI, Section B, line 11 | The CEO and CFO review the 990. The 990 is then provided to each board member for their review prior to the actual filing of the 990. | |
| Form 990, Part VI, Section B, line 12c | St. Michael's Hospital Conflict of Interest Policy covers any director/trustee, officer, member of a committee with Board-delegated powers, member of management who has a direct or indirect financial interest, CEO and CFO as well as their family members. SMH requires any director/trustee, Board committee member, officer and member of management to disclose the existence of a financial interest, other actual or possible conflict of interest and all material facts annually by completing a disclosure statement; and if a conflict of interest arises after the completion of the annual disclosure, at the time the new conflict arises. The Board of Directors makes the determination as to whether a conflict of interest exists. The Board of Directors addresses conflict of interests via a formalized procedure. This procedure may include a presentation by the interested person, but excludes the interested person from further discussion or voting on the transaction or arrangement that may constitute a conflict of interest. The Board of Directors also include a standing agenda item at the beginning of each meeting which requires the disclosure of potential conflict of interest for any items included on the agenda. | |
| Form 990, Part VI, Section B, line 15 | Compensation for the CEO is determined by SMH's Board of Directors. This compensation process includes an annual performance review and comparability data. The CEO determines the compensation for other members of management including the CFO based on an annual performance appraisal and use of comparability data. | |
| Form 990, Part VI, Section C, line 19 | The documents are not available to the public. | |
| Form 990, Part XI, line 5: | Net unrealized losses on investments: -66,640. | Changes in Net Assets or Fund Balances: |
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