COTEAU DES PRAIRIES HOSPITAL: Form 990, tax year 2012

View the entire original 990 at ProPublica ↗

Organization: COTEAU DES PRAIRIES HOSPITAL (EIN 46-0278210)
Tax period: 2012-01-01 to 2012-12-31
Filed: 2013-11-12
IRS object ID: 201333169349304918
Schema version: 2012v2.1
Source: Download XML · Original 990 at ProPublica

Every field in the e-filed return. Faint text is the IRS element name, for citing.

Return header
Form 990
Schedule A
Schedule B
Schedule D
Schedule H
Schedule J
Schedule K
Schedule O

Return header ReturnHeader

Field	Value	IRS element (for citing)
Timestamp	2013-11-12T14:59:48-06:00	Timestamp
Tax Period End Date	2012-12-31	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 Suite 500	AddressLine1
City	Sioux Falls	City
State	SD	State
ZIP Code	571045126	ZIPCode

Field	Value	IRS element (for citing)
Return Type	990	ReturnType
Tax Period Begin Date	2012-01-01	TaxPeriodBeginDate

Filer Filer

Field	Value	IRS element (for citing)
EIN	460278210	EIN

Name Name

Field	Value	IRS element (for citing)
Business Name Line1	Coteau des Prairies Hospital	BusinessNameLine1

Field	Value	IRS element (for citing)
Name Control	COTE	NameControl
Phone	6056987647	Phone

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

Officer Officer

Field	Value	IRS element (for citing)
Name	Dan Ellis	Name
Title	CEO	Title
Phone	6056987647	Phone
Date Signed	2013-11-12	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	2013-11-12	DatePrepared

Field	Value	IRS element (for citing)
Tax Year	2012	TaxYear
Build TS	2016-02-24 21:20:13Z	BuildTS

Form 990 IRS990

Field	Value	IRS element (for citing)
Name Of Principal Officer Person	Dan Ellis	NameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

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	13225528	GrossReceipts
Group Return For Affiliates	0	GroupReturnForAffiliates
Organization501c3	X	Organization501c3
Web Site	www.cdphospital.com	WebSite
Type Of Organization Corporation	X	TypeOfOrganizationCorporation
Year Formation	1967	YearFormation
State Legal Domicile	SD	StateLegalDomicile
Activity Or Mission Description	Provision of healthcare services to the population of Sisseton, SD, and the surrounding area.	ActivityOrMissionDescription
Nbr Voting Members Governing Body	12	NbrVotingMembersGoverningBody
Nbr Independent Voting Members	12	NbrIndependentVotingMembers
Total Nbr Employees	181	TotalNbrEmployees
Total Nbr Volunteers	20	TotalNbrVolunteers
Total Gross UBI	0	TotalGrossUBI
Net Unrelated Business Txbl Income	0	NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year	88340	ContributionsGrantsPriorYear
Contributions Grants Current Year	88129	ContributionsGrantsCurrentYear
Program Service Revenue Prior Year	12586153	ProgramServiceRevenuePriorYear
Program Service Revenue CY	13095018	ProgramServiceRevenueCY
Investment Income Prior Year	3989	InvestmentIncomePriorYear
Investment Income Current Year	8371	InvestmentIncomeCurrentYear
Other Revenue Prior Year	17309	OtherRevenuePriorYear
Other Revenue Current Year	18171	OtherRevenueCurrentYear
Total Revenue Prior Year	12695791	TotalRevenuePriorYear
Total Revenue Current Year	13209689	TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year	2000	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	6561613	SalariesEtcPriorYear
Salaries Etc Current Year	7074864	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	5523717	OtherExpensePriorYear
Other Expenses Current Year	5587819	OtherExpensesCurrentYear
Total Expenses Prior Year	12087330	TotalExpensesPriorYear
Total Expenses Current Year	12662683	TotalExpensesCurrentYear
Revenues Less Expenses Prior Year	608461	RevenuesLessExpensesPriorYear
Revenues Less Expenses CY	547006	RevenuesLessExpensesCY
Total Assets BOY	7740033	TotalAssetsBOY
Total Assets EOY	9284464	TotalAssetsEOY
Total Liabilities BOY	1258793	TotalLiabilitiesBOY
Total Liabilities EOY	2256218	TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY	6481240	NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY	7028246	NetAssetsOrFundBalancesEOY
Mission Description	Quality healthcare with a personal touch close to home.	MissionDescription
Significant New Program Services	0	SignificantNewProgramServices
Significant Change	0	SignificantChange
Expense	10889085	Expense
Revenue	13095018	Revenue
Description	Coteau des Prairies Hospital (CDPH) is a 25 bed acute care hospital and physician clinic. The hospital provides healthcare services for the care and treatment of any persons who are acutely ill or who otherwise require medical care and related services. Statistics for the period ended December 31, 2012, are as follows: acute patient days = 1,274, subacute patient days = 660, newborn days = 281, and emergency room visits = 5,270.	Description
Total Program Service Expense	10889085	TotalProgramServiceExpense
Described In501 C3	1	DescribedIn501C3
Schedule B Required	1	ScheduleBRequired
Political Activities	0	PoliticalActivities
Lobbying Activities	0	LobbyingActivities
Subject To Proxy Tax	0	SubjectToProxyTax
Donor Advised Funds	0	DonorAdvisedFunds
Conservation Easements	0	ConservationEasements
Collections Of Art	0	CollectionsOfArt
Credit Counseling	0	CreditCounseling
Term Or Permanent Endowments	0	TermOrPermanentEndowments
Report Land Bldg Equip	1	ReportLandBldgEquip
Report Invest Oth Securities	0	ReportInvestOthSecurities
Report Prog Rel Invest	0	ReportProgRelInvest
Report Other Assets	0	ReportOtherAssets
Report Other Liabilities	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	1	TaxExemptBonds
Invest Tax Exempt Bonds	0	InvestTaxExemptBonds
Escrow Account	0	EscrowAccount
On Behalf Of Issuer	0	OnBehalfOfIssuer
Excess Benefit Transaction	0	ExcessBenefitTransaction
Prior Excess Benefit Transaction	0	PriorExcessBenefitTransaction
Loan To Officer Or DQP	0	LoanToOfficerOrDQP
Grant To Related Person	0	GrantToRelatedPerson
Bsnss Rltnshp With Organization	0	BsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family Member	0	BsnssRltnshpThruFamilyMember
Officer Entity With Bsnss Rltnshp	0	OfficerEntityWithBsnssRltnshp
Deductible Non Cash Contributions	0	DeductibleNonCashContributions
Deductible Contributions Of Art	0	DeductibleContributionsOfArt
Terminated	0	Terminated
Partial Liquidation	0	PartialLiquidation
Disregarded Entity	0	DisregardedEntity
Related Entity	0	RelatedEntity
Related Org Controlled Entity	0	RelatedOrgControlledEntity
Transfers To Exempt Non Chrtbl Org	0	TransfersToExemptNonChrtblOrg
Activities Conducted Partnership	0	ActivitiesConductedPartnership
Schedule O Required	1	ScheduleORequired
Number Forms Transmitted With1096	7	NumberFormsTransmittedWith1096
Number W2 G Included	0	NumberW2GIncluded
Compliance With Backup Witholding	1	ComplianceWithBackupWitholding
Number Of Employees	181	NumberOfEmployees
Employment Tax Returns Filed	1	EmploymentTaxReturnsFiled
Unrelated Business Income	0	UnrelatedBusinessIncome
Foreign Financial Account	0	ForeignFinancialAccount
Prohibited Tax Shelter Trans	0	ProhibitedTaxShelterTrans
Taxable Party Notification	0	TaxablePartyNotification
Non Deductible Contributions	0	NonDeductibleContributions
Quid Pro Quo Contributions	0	QuidProQuoContributions
Form8282 Property Disposed Of	0	Form8282PropertyDisposedOf
Funds To Pay Premiums	0	FundsToPayPremiums
Premiums Paid	0	PremiumsPaid
Indoor Tanning Services	0	IndoorTanningServices
Info In Schedule O Part VI	X	InfoInScheduleOPartVI
Nbr Voting Governing Body Members	12	NbrVotingGoverningBodyMembers
Number Independent Voting Members	12	NumberIndependentVotingMembers
Family Or Business Relationship	0	FamilyOrBusinessRelationship
Delegation Of Management Duties	0	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	0	Form990ProvidedToGoverningBody
Conflict Of Interest Policy	1	ConflictOfInterestPolicy
Annual Disclosure Covered Persons	1	AnnualDisclosureCoveredPersons
Regular Monitoring Enforcement	1	RegularMonitoringEnforcement
Whistleblower Policy	1	WhistleblowerPolicy
Document Retention Policy	1	DocumentRetentionPolicy
Compensation Process CEO	1	CompensationProcessCEO
Compensation Process Other	1	CompensationProcessOther
Investment In Joint Venture	0	InvestmentInJointVenture
Upon Request	X	UponRequest

The Books Are In Care Of TheBooksAreInCareOf

Name Business NameBusiness

Field	Value	IRS element (for citing)
Business Name Line1	Larry Moen	BusinessNameLine1

Field	Value	IRS element (for citing)
Telephone Number	6056984697	TelephoneNumber

Address US AddressUS

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 Form990PartVIISectionA (19 entries)

TitleTitle	Average Hours Per WeekAverageHoursPerWeek	Individual Trustee Or DirectorIndividualTrusteeOrDirector	OfficerOfficer	Reportable Comp From OrganizationReportableCompFromOrganization	Reportable Comp From Related OrgsReportableCompFromRelatedOrgs	Other CompensationOtherCompensation	Highest Compensated EmployeeHighestCompensatedEmployee
Mary Carlson
President	2.00	X	X	0	0	0
Faye Johnston
Vice President	2.00	X	X	0	0	0
Terry Jaspers
Treasurer	2.00	X	X	0	0	0
DelRay German
Secretary	2.00	X	X	0	0	0
Debbie Wooley
Member	1.00	X		0	0	0
Steven McCleerey
Member	1.00	X		0	0	0
Erin Cameron
Member	1.00	X		0	0	0
Cheryl Karst
Member	1.00	X		0	0	0
Vivian Hove
Member	1.00	X		0	0	0
Geri Opsal
Member	1.00	X		0	0	0
Jay Hill
Member	1.00	X		0	0	0
Kent Thoelke
Member	1.00	X		0	0	0
Dan Ellis
CEO	40.00		X	124004	0	21294
Larry Moen
CFO	40.00		X	73224	0	12612
Dr Stanley Gallagher
MD	40.00			584548	0	7023	X
Dr Judy Beumer
MD	32.00			411950	0	26544	X
Dr David Staub
MD	20.00			348039	0	9540	X
Dr Linda Peterson
MD	24.00			166578	0	6359	X
Bradley Gallagher
PA	40.00			104447	0	6125	X

Field	Value	IRS element (for citing)
Total Reportable Comp From Org	1812790	TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs	0	TotalReportableCompFrmRltdOrgs
Total Other Compensation	89497	TotalOtherCompensation
Number Individuals GT100 K	6	NumberIndividualsGT100K
Formers Listed	0	FormersListed
Total Comp GT150 K	1	TotalCompGT150K
Compensation From Other Sources	0	CompensationFromOtherSources

Contractor Compensation ContractorCompensation

Name Of Contractor NameOfContractor

Field	Value	IRS element (for citing)
Name Person	Charles Pryzmus	NamePerson

Address Of Contractor AddressOfContractor

Address US AddressUS

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)
Description Of Services	Anesthesia Services	DescriptionOfServices
Compensation	166760	Compensation

Field	Value	IRS element (for citing)
Number Of Contractors GT100 K	1	NumberOfContractorsGT100K
Government Grants	87512	GovernmentGrants
All Other Contributions	617	AllOtherContributions
Total Contributions	88129	TotalContributions

Program Service Revenue ProgramServiceRevenue (3 entries)

DescriptionDescription	Business CodeBusinessCode	Total Revenue ColumnTotalRevenueColumn	Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome
Patient Service Revenue	622110	13037756	13037756
Misc Revenue	900099	35095	35095
Cafeteria Revenue	900099	22167	22167

Field	Value	IRS element (for citing)
Total Program Service Revenue	13095018	TotalProgramServiceRevenue

Investment Income InvestmentIncome

Field	Value	IRS element (for citing)
Total Revenue Column	3816	TotalRevenueColumn
Exclusion	$3,816	ExclusionAmount

Gross Rents GrossRents

Field	Value	IRS element (for citing)
Real	18171	Real

Less Rental Expenses LessRentalExpenses

Field	Value	IRS element (for citing)
Real	0	Real

Rental Income Or Loss RentalIncomeOrLoss

Field	Value	IRS element (for citing)
Real	18171	Real

Net Rental Income Or Loss NetRentalIncomeOrLoss

Field	Value	IRS element (for citing)
Total Revenue Column	18171	TotalRevenueColumn
Exclusion	$18,171	ExclusionAmount

Gross Amount Sales Assets GrossAmountSalesAssets

Field	Value	IRS element (for citing)
Other	20394	Other

Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses

Field	Value	IRS element (for citing)
Other	15839	Other

Gain Or Loss GainOrLoss

Field	Value	IRS element (for citing)
Other	4555	Other

Net Gain Or Loss Investments NetGainOrLossInvestments

Field	Value	IRS element (for citing)
Total Revenue Column	4555	TotalRevenueColumn
Exclusion	$4,555	ExclusionAmount

Total Revenue TotalRevenue

Field	Value	IRS element (for citing)
Total Revenue Column	13209689	TotalRevenueColumn
Related Or Exempt Function Income	13095018	RelatedOrExemptFunctionIncome
Unrelated Business Revenue	0	UnrelatedBusinessRevenue
Exclusion	$26,542	ExclusionAmount

Comp Current Officers Directors CompCurrentOfficersDirectors

Field	Value	IRS element (for citing)
Total	221491	Total
Management And General	221491	ManagementAndGeneral

Other Salaries And Wages OtherSalariesAndWages

Field	Value	IRS element (for citing)
Total	5600341	Total
Program Services	5095133	ProgramServices
Management And General	505208	ManagementAndGeneral

Pension Plan Contributions PensionPlanContributions

Field	Value	IRS element (for citing)
Total	116798	Total
Program Services	103254	ProgramServices
Management And General	13544	ManagementAndGeneral

Other Employee Benefits OtherEmployeeBenefits

Field	Value	IRS element (for citing)
Total	394549	Total
Program Services	348933	ProgramServices
Management And General	45616	ManagementAndGeneral

Payroll Taxes PayrollTaxes

Field	Value	IRS element (for citing)
Total	741685	Total
Program Services	651822	ProgramServices
Management And General	89863	ManagementAndGeneral

Fees For Services Legal FeesForServicesLegal

Field	Value	IRS element (for citing)
Total	17281	Total
Management And General	17281	ManagementAndGeneral

Fees For Services Accounting FeesForServicesAccounting

Field	Value	IRS element (for citing)
Total	39600	Total
Management And General	39600	ManagementAndGeneral

Fees For Services Other FeesForServicesOther

Field	Value	IRS element (for citing)
Total	918784	Total
Program Services	797551	ProgramServices
Management And General	121233	ManagementAndGeneral

Advertising Advertising

Field	Value	IRS element (for citing)
Total	46957	Total
Management And General	46957	ManagementAndGeneral

Office Expenses OfficeExpenses

Field	Value	IRS element (for citing)
Total	362300	Total
Program Services	270806	ProgramServices
Management And General	91494	ManagementAndGeneral

Information Technology InformationTechnology

Field	Value	IRS element (for citing)
Total	380664	Total
Management And General	380664	ManagementAndGeneral

Occupancy Occupancy

Field	Value	IRS element (for citing)
Total	167860	Total
Program Services	144906	ProgramServices
Management And General	22954	ManagementAndGeneral

Travel Travel

Field	Value	IRS element (for citing)
Total	35333	Total
Program Services	29141	ProgramServices
Management And General	6192	ManagementAndGeneral

Conferences Meetings ConferencesMeetings

Field	Value	IRS element (for citing)
Total	141168	Total
Program Services	122573	ProgramServices
Management And General	18595	ManagementAndGeneral

Depreciation Depletion DepreciationDepletion

Field	Value	IRS element (for citing)
Total	379581	Total
Program Services	379581	ProgramServices

Insurance Insurance

Field	Value	IRS element (for citing)
Total	110363	Total
Management And General	110363	ManagementAndGeneral

Other Expenses OtherExpenses (4 entries)

DescriptionDescription	TotalTotal	Program ServicesProgramServices	Management And GeneralManagementAndGeneral
Medical Supplies	1949927	1949927
Bad Debt	499992	499992
Equipment Rental and Ma	452335	450607	1728
License and Permits	39122	37986	1136

All Other Expenses AllOtherExpenses

Field	Value	IRS element (for citing)
Total	46552	Total
Program Services	6873	ProgramServices
Management And General	39679	ManagementAndGeneral

Total Functional Expenses TotalFunctionalExpenses

Field	Value	IRS element (for citing)
Total	12662683	Total
Program Services	10889085	ProgramServices
Management And General	1773598	ManagementAndGeneral
Fundraising	0	Fundraising

Savings And Temp Cash Investments SavingsAndTempCashInvestments

Field	Value	IRS element (for citing)
BOY	1311738	BOY
EOY	2107360	EOY

Accounts Receivable AccountsReceivable

Field	Value	IRS element (for citing)
BOY	3633857	BOY
EOY	2965623	EOY

Inventories For Sale Or Use InventoriesForSaleOrUse

Field	Value	IRS element (for citing)
BOY	187288	BOY
EOY	244437	EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

Field	Value	IRS element (for citing)
BOY	119729	BOY
EOY	97814	EOY

Field	Value	IRS element (for citing)
Land Buildings Equipment Basis	9781531	LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec	5912301	LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

Field	Value	IRS element (for citing)
BOY	2487421	BOY
EOY	3869230	EOY

Total Assets TotalAssets

Field	Value	IRS element (for citing)
BOY	7740033	BOY
EOY	9284464	EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

Field	Value	IRS element (for citing)
BOY	1258793	BOY
EOY	1021347	EOY

Tax Exempt Bond Liabilities TaxExemptBondLiabilities

Field	Value	IRS element (for citing)
EOY	1234871	EOY

Total Liabilities TotalLiabilities

Field	Value	IRS element (for citing)
BOY	1258793	BOY
EOY	2256218	EOY

Field	Value	IRS element (for citing)
Follow SFAS117	X	FollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

Field	Value	IRS element (for citing)
BOY	6481240	BOY
EOY	7028246	EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

Field	Value	IRS element (for citing)
BOY	6481240	BOY
EOY	7028246	EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

Field	Value	IRS element (for citing)
BOY	7740033	BOY
EOY	9284464	EOY

Field	Value	IRS element (for citing)
Reconcilation Revenue Expenses	547006	ReconcilationRevenueExpenses
Reconcilation Other Changes	0	ReconcilationOtherChanges
Method Of Accounting Accrual	X	MethodOfAccountingAccrual
Accountant Compile Or Review	0	AccountantCompileOrReview
FS Audited	1	FSAudited

FS Audited Basis FSAuditedBasis

Field	Value	IRS element (for citing)
Financial Statement Separate	X	FinancialStatementSeparate

Field	Value	IRS element (for citing)
Audit Committee	0	AuditCommittee
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

Land Land

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	13556	OtherCostOrOtherBasis
Book Value	13556	BookValue

Buildings Buildings

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	3663885	OtherCostOrOtherBasis
Depreciation	2524485	Depreciation
Book Value	1139400	BookValue

Equipment Equipment

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	4397488	OtherCostOrOtherBasis
Depreciation	3283067	Depreciation
Book Value	1114421	BookValue

Other Land Buildings OtherLandBuildings

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	1706602	OtherCostOrOtherBasis
Depreciation	104749	Depreciation
Book Value	1601853	BookValue

Field	Value	IRS element (for citing)
Total Of Book Value Land Buildings	3869230	TotalOfBookValueLandBuildings
Footnote In Part XIII	X	FootnoteInPartXIII
Tot Revenue Etc Audited Fincl Stmt	12709697	TotRevenueEtcAuditedFinclStmt
Revenue Not Rptd F990	0	RevenueNotRptdF990
Revenue Subtotal	12709697	RevenueSubtotal
Other Revenues Not Included	499992	OtherRevenuesNotIncluded
Revenue Not Rptd On Fin Stmt	499992	RevenueNotRptdOnFinStmt
Total Revenue Per Form990	13209689	TotalRevenuePerForm990
Tot Expenses Etc Audited Fincl Stmt	12162691	TotExpensesEtcAuditedFinclStmt
Expenses Not Rptd F990	0	ExpensesNotRptdF990
Expenses Subtotal	12162691	ExpensesSubtotal
Other Expenses Not Included	499992	OtherExpensesNotIncluded
Expenses Not Rptd On Fin Stmt	499992	ExpensesNotRptdOnFinStmt
Total Expenses Per Form990	12662683	TotalExpensesPerForm990

Form990 Schedule D Part XIII Form990ScheduleDPartXIII (3 entries)

IdentifierIdentifier	Return ReferenceReturnReference	ExplanationExplanation
Description of Uncertain Tax Positions Under FIN 48:	Part X, Line 2:	The 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 4b - Other Adjustments:		Provision for Bad Debts 499,992.
Part XII, Line 4b - Other Adjustments:		Provision for Bad Debts 499,992.

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
Pcent150	X	Pcent150
FPG Reference Discounted Care	1	FPGReferenceDiscountedCare

Discounted Other DiscountedOther

Field	Value	IRS element (for citing)
Other	X	Other
Discounted Other Percentage	175.000000000000	DiscountedOtherPercentage

Field	Value	IRS element (for citing)
Free Disc Care Medically Indigent	1	FreeDiscCareMedicallyIndigent
Amounts Budgeted For Charity Care	1	AmountsBudgetedForCharityCare
Expenses Exceeded Budget	0	ExpensesExceededBudget
Annual Community Benefit Report	0	AnnualCommunityBenefitReport

Charity Care At Cost CharityCareAtCost

Field	Value	IRS element (for citing)
Total Community Benefit Expense	50200	TotalCommunityBenefitExpense
Net Community Benefit Expense	50200	NetCommunityBenefitExpense
Percent Of Total Expense	0.00400	PercentOfTotalExpense

Unreimbursed Medicaid UnreimbursedMedicaid

Field	Value	IRS element (for citing)
Total Community Benefit Expense	1243681	TotalCommunityBenefitExpense
Direct Offsetting Revenue	1213362	DirectOffsettingRevenue
Net Community Benefit Expense	30319	NetCommunityBenefitExpense
Percent Of Total Expense	0.00240	PercentOfTotalExpense

Total Charity Care TotalCharityCare

Field	Value	IRS element (for citing)
Total Community Benefit Expense	1293881	TotalCommunityBenefitExpense
Direct Offsetting Revenue	1213362	DirectOffsettingRevenue
Net Community Benefit Expense	80519	NetCommunityBenefitExpense
Percent Of Total Expense	0.00640	PercentOfTotalExpense

Community Health Services CommunityHealthServices

Field	Value	IRS element (for citing)
Total Community Benefit Expense	10783	TotalCommunityBenefitExpense
Direct Offsetting Revenue	6479	DirectOffsettingRevenue
Net Community Benefit Expense	4304	NetCommunityBenefitExpense
Percent Of Total Expense	0.00030	PercentOfTotalExpense

Health Professions Education HealthProfessionsEducation

Field	Value	IRS element (for citing)
Total Community Benefit Expense	1250	TotalCommunityBenefitExpense
Net Community Benefit Expense	1250	NetCommunityBenefitExpense
Percent Of Total Expense	0.00010	PercentOfTotalExpense

Subsidized Health Services SubsidizedHealthServices

Field	Value	IRS element (for citing)
Total Community Benefit Expense	2861341	TotalCommunityBenefitExpense
Direct Offsetting Revenue	1481024	DirectOffsettingRevenue
Net Community Benefit Expense	1380317	NetCommunityBenefitExpense
Percent Of Total Expense	0.10900	PercentOfTotalExpense

Cash And In Kind Contributions CashAndInKindContributions

Field	Value	IRS element (for citing)
Total Community Benefit Expense	1060	TotalCommunityBenefitExpense
Net Community Benefit Expense	1060	NetCommunityBenefitExpense
Percent Of Total Expense	0.00010	PercentOfTotalExpense

Total Other Benefits TotalOtherBenefits

Field	Value	IRS element (for citing)
Total Community Benefit Expense	2874434	TotalCommunityBenefitExpense
Direct Offsetting Revenue	1487503	DirectOffsettingRevenue
Net Community Benefit Expense	1386931	NetCommunityBenefitExpense
Percent Of Total Expense	0.10950	PercentOfTotalExpense

Total Community Benefits TotalCommunityBenefits

Field	Value	IRS element (for citing)
Total Community Benefit Expense	4168315	TotalCommunityBenefitExpense
Direct Offsetting Revenue	2700865	DirectOffsettingRevenue
Net Community Benefit Expense	1467450	NetCommunityBenefitExpense
Percent Of Total Expense	0.11590	PercentOfTotalExpense

Field	Value	IRS element (for citing)
Bad Debt Expense Reported	0	BadDebtExpenseReported
Bad Debt Expense	$499,992	BadDebtExpenseAmount
Amount Attributable To	249996	AmountAttributableTo
Amount Reimbursed By Medicare	2981225	AmountReimbursedByMedicare
Cost Of Care Reimbursed By Medicare	2951708	CostOfCareReimbursedByMedicare
Medicare Surplus Or Shortfall	29517	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	0	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	Coteau des Prairies Hospital & Clinic	BusinessNameLine1

Address Address

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)
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	Coteau des Prairies Hospital & Clinic	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	150.000000000000	FPGFreePercent
Uses FPG Discounted	1	UsesFPGDiscounted
FPG Discount Percent	175.000000000000	FPGDiscountPercent
Explains Basis	1	ExplainsBasis
Income Level	X	IncomeLevel
Asset Level	X	AssetLevel
Medical Indigency	X	MedicalIndigency
Insurance Status	X	InsuranceStatus
Medicaid Medicare	X	MedicaidMedicare
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
Other Actions Taken	X	OtherActionsTaken
Nondiscrim Emergency Care Policy	1	NondiscrimEmergencyCarePolicy
Medicare Rate	X	MedicareRate
Amounts Generally Billed	0	AmountsGenerallyBilled
Gross Charges	0	GrossCharges

Form990 Schedule H Part V Section C Form990ScheduleHPartVSectionC

Field	Value	IRS element (for citing)
Number Of Other Facilities	4	NumberOfOtherFacilities

Other Facilities OtherFacilities (4 entries)

Address Line1Address/AddressLine1	CityAddress/City	StateAddress/State	ZIP CodeAddress/ZIPCode	Facility TypeFacilityType
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
Coteau Des Prairies Clinic
205 Orchard Drive	Sisseton	SD	57262	Rural Health Clinic
Herman Clinic
204 5th St East	Herman	MN	56248	Family Practice Clinic

Form990 Schedule H Part VI Form990ScheduleHPartVI (13 entries)

ExplanationExplanation	IdentifierIdentifier
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. Line 7b was determined using the ratio of patient care costs to charges calculated in IRS Worksheet 2. Line 7e, 7f, and 7i were obtained utilizing the actual general ledger system. Line 7g was obtained from the Medicare cost report.
Part I, L7 Col(f): Bad debt expense of $499,992 was subtracted from total operating expense.
Part II: None
Part III, Line 4: a) 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. b) Bad debt expense attributable to charity care is estimated based on income levels and ethnicity in this area. More that 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. c) Footnote from Financial Statement: Patient receivables are uncollateralized patient and third-party payor obligations. Unpaid patient receivables do not have any interest assessed.Payments of patient receivables are allocated to the specific claims identified on the remittance advice or, if unspecified, are applied to the earliest unpaid claim.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. The Hospital's process for calculating the allowance for doubtful accounts for self-pay patients has not significantly changed from December 31, 2011 to December 31, 2012. The Hospital does not maintain a material allowance for doubtful accounts from third-party payors, nor did it have significant write offs from third-party payors. The Hospital has not significantly changed its charity care or uninsured discount policies during fiscal years 2012 or 2011.
Part III, Line 8: Medicare allowable cost of care was calculated from the Medicare cost report for the period ending 12/31/2012. The Medicare cost report was filed in accordance with the audited financial statements.
Part V, Section B, Line 14g: A summary of the policy was posted in the hospital facility emergency rooms or waiting rooms and in the admissions offices.	Coteau des Prairies Hospital & Clinic
Part V, Section B, Line 18e: Prior to initiating any collection actions listed above, patients are made aware of the financial assistance policy through signage in admissions, and phone calls by hospital staff prior to being sent to collection. Patients accounts are not sent to collection until patients have been offered the financial assistance policy.	Coteau des Prairies Hospital & Clinic
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 is in the process of finalizing its implementation strategy and anticipates making the community health needs assessment and implementation strategy widely available by December 31, 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 estimated population in Sisseton, SD in 2012 was 2,470. Approximately 47.04% of the Sisseton area people are white, 47.81% are Native American, 0.08% are Black, 0.4% are Asian, 0.80% claim Hispanic, and 4.66% claim "Other".The estimated population in Roberts County, SD in 2012 was 10,303. Approximately 60.4% of Roberts County area people are white, 35.9% are native American, 0.2% are Black, 0.3% are Asian, and 1.6% claim Hispanic, and 1.6% claim "Other".
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	X	CompensationCommittee
Written Employment Contract	X	WrittenEmploymentContract
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 (4 entries)

TitleTitle	Base Compensation Filing OrgBaseCompensationFilingOrg	Comp Based On Related OrgsCompBasedOnRelatedOrgs	Bonus Filing OrgBonusFilingOrg	Bonus Related OrgsBonusRelatedOrgs	Other Compensation Filing OrgOtherCompensationFilingOrg	Other Compensation Related OrgsOtherCompensationRelatedOrgs	Deferred Comp Filing OrgDeferredCompFilingOrg	Deferred Comp Related OrgsDeferredCompRelatedOrgs	Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrg	Nontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgs	Total Compensation Filing OrgTotalCompensationFilingOrg	Total Compensation Related OrgsTotalCompensationRelatedOrgs	Comp Report Prior990 Filing OrgCompReportPrior990FilingOrg	Comp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs
Dr Stanley Gallagher
MD	584548	0	0	0	0	0	0	0	7023	0	591571	0	0	0
Dr Judy Beumer
MD	411950	0	0	0	0	0	9800	0	16744	0	438494	0	0	0
Dr David Staub
MD	348039	0	0	0	0	0	0	0	9540	0	357579	0	0	0
Dr Linda Peterson
MD	166578	0	0	0	0	0	0	0	6359	0	172937	0	0	0

Form990 Schedule J Part III Form990ScheduleJPartIII

Field	Value	IRS element (for citing)
Return Reference	Part I, Line 5	ReturnReference
Explanation	Physicians are paid 38% of their respective provider/CPT code revenue.	Explanation

Schedule K IRS990ScheduleK

Form990 Schedule K Part I Form990ScheduleKPartI

Field	Value	IRS element (for citing)
Bond Reference	A	BondReferenceCd

Issuer Name IssuerName

Field	Value	IRS element (for citing)
Business Name Line1	City of Sisseton South Dakota	BusinessNameLine1

Field	Value	IRS element (for citing)
Issuer EIN	466000460	IssuerEIN
Date Issued	2012-07-06	DateIssued
Issue Price	7450000	IssuePrice
Description Of Purpose	Fund hospital remodeling and building addition project	DescriptionOfPurpose
Defeased	0	Defeased
On Behalf Of Issuer	0	OnBehalfOfIssuer
Pool Financing	0	PoolFinancing

Form990 Schedule K Part II Form990ScheduleKPartII

Field	Value	IRS element (for citing)
Bond Reference	A	BondReferenceCd
Total Proceeds	7450000	TotalProceeds
Issuance Costs From Proceeds	122280	IssuanceCostsFromProceeds
Capital Expenditures	1234871	CapitalExpenditures
Amount Unspent	6092849	AmountUnspent
Current Refunding	0	CurrentRefunding
Advance Refunding	0	AdvanceRefunding
Final Allocation Made	0	FinalAllocationMade
Adequate Books And Recds Maintaind	1	AdequateBooksAndRecdsMaintaind

Form990 Schedule K Part III Form990ScheduleKPartIII

Field	Value	IRS element (for citing)
Bond Reference	A	BondReferenceCd
Owning Bond Financed Property	0	OwningBondFinancedProperty
Any Lease Arrangements	0	AnyLeaseArrangements
Mngment Cntrct Bond Financd Prprty	0	MngmentCntrctBondFinancdPrprty
Any Research Agreements	0	AnyResearchAgreements
Prcntge Prvt Business Use By Others	0.00000	PrcntgePrvtBusinessUseByOthers
Percentage Of Prvt Business Re UBI	0.00000	PercentageOfPrvtBusinessReUBI
Total Private Business Use	0.00000	TotalPrivateBusinessUse
Bond Iss Meet Prvt Security Pay Test	0	BondIssMeetPrvtSecurityPayTest
Change In Use Bond Financed Prop	0	ChangeInUseBondFinancedProp
Non Qualified Bond Remed Procdrs	1	NonQualifiedBondRemedProcdrs

Form990 Schedule K Part IV Form990ScheduleKPartIV

Field	Value	IRS element (for citing)
Bond Reference	A	BondReferenceCd
Form8038 T Filed	0	Form8038TFiled
Rebate Not Due Yet	0	RebateNotDueYet
Exception To Rebate	0	ExceptionToRebate
No Rebate Due	0	NoRebateDue
Variable Rate Issue	0	VariableRateIssue
Hedge Identified In Books And Recds	0	HedgeIdentifiedInBooksAndRecds
Gross Proceeds Invested In GIC	0	GrossProceedsInvestedInGIC
Gross Proceeds Invested	0	GrossProceedsInvested
Written Proc To Monitor Reqs	1	WrittenProcToMonitorReqs

Form990 Schedule K Part V Form990ScheduleKPartV

Field	Value	IRS element (for citing)
Bond Reference	A	BondReferenceCd
Proc To Undertk Corrective Action	1	ProcToUndertkCorrectiveAction

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (5 entries)

Return ReferenceReturnReference	ExplanationExplanation
Form 990, Part VI, Section A, line 8b	No committees with authority to act on behalf of the governing body.
Form 990, Part VI, Section B, line 11	The Director of Finance reviews the 990 in detail prior to filing the return.
Form 990, Part VI, Section B, line 12c	All board members and officers are covered by the Conflict of Interest Policy. 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.