COTEAU DES PRAIRIES HOSPITAL: Form 990, tax year 2011

View the entire original 990 at ProPublica ↗

Organization: COTEAU DES PRAIRIES HOSPITAL (EIN 46-0278210)
Tax period: 2011-01-01 to 2011-12-31
Filed: 2012-11-09
IRS object ID: 201243149349301324
Schema version: 2011v1.2
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 O

Return header ReturnHeader

Field	Value	IRS element (for citing)
Timestamp	2012-11-09T11:50:58-06:00	Timestamp
Tax Period End Date	2011-12-31	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	2011-01-01	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	2012-11-09	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	2012-11-09	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	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	13170791	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	176	TotalNbrEmployees
Total Nbr Volunteers	20	TotalNbrVolunteers
Total Gross UBI	0	TotalGrossUBI
Net Unrelated Business Txbl Income	0	NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year	0	ContributionsGrantsPriorYear
Contributions Grants Current Year	88340	ContributionsGrantsCurrentYear
Program Service Revenue Prior Year	1030016	ProgramServiceRevenuePriorYear
Program Service Revenue CY	12586153	ProgramServiceRevenueCY
Investment Income Prior Year	1116	InvestmentIncomePriorYear
Investment Income Current Year	3989	InvestmentIncomeCurrentYear
Other Revenue Prior Year	2000	OtherRevenuePriorYear
Other Revenue Current Year	17309	OtherRevenueCurrentYear
Total Revenue Prior Year	1033132	TotalRevenuePriorYear
Total Revenue Current Year	12695791	TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year	0	GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY	2000	GrantsAndSimilarAmntsCY
Benefits Paid To Members Prior Year	0	BenefitsPaidToMembersPriorYear
Benefits Paid To Members CY	0	BenefitsPaidToMembersCY
Salaries Etc Prior Year	391877	SalariesEtcPriorYear
Salaries Etc Current Year	6561613	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	467545	OtherExpensePriorYear
Other Expenses Current Year	5523717	OtherExpensesCurrentYear
Total Expenses Prior Year	859422	TotalExpensesPriorYear
Total Expenses Current Year	12087330	TotalExpensesCurrentYear
Revenues Less Expenses Prior Year	173710	RevenuesLessExpensesPriorYear
Revenues Less Expenses CY	608461	RevenuesLessExpensesCY
Total Assets BOY	6405548	TotalAssetsBOY
Total Assets EOY	7740033	TotalAssetsEOY
Total Liabilities BOY	532769	TotalLiabilitiesBOY
Total Liabilities EOY	1258793	TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY	5872779	NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY	6481240	NetAssetsOrFundBalancesEOY
Mission Description	QUALITY HEALTHCARE WITH A PERSONAL TOUCH CLOSE TO HOME.	MissionDescription
Significant New Program Services	0	SignificantNewProgramServices
Significant Change	0	SignificantChange
Expense	10528281	Expense
Grants	2000	Grants
Revenue	12586153	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, 2011, ARE AS FOLLOWS: ACUTE PATIENT DAYS = 1,303, SUBACUTE PATIENT DAYS = 913, NEWBORN DAYS = 323, AND EMERGENCY ROOM VISITS = 4,479.	Description
Total Program Service Expense	10528281	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	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	9	NumberFormsTransmittedWith1096
Number W2 G Included	0	NumberW2GIncluded
Compliance With Backup Witholding	1	ComplianceWithBackupWitholding
Number Of Employees	176	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	1	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	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 (21 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
DELRAY GERMAN
SECRETARY	1.00	X	X	0	0	0
TERRY JASPERS
TREASURER	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
CLAYTON HALVERSON THRU JAN 2011
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
TOM WAGNER THRU JULY 2011
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	121014	0	15623
LARRY MOEN
CFO	40.00		X	71642	0	8087
DR STANLEY GALLAGHER
MD	40.00			460411	0	6981	X
DR JUDY BEUMER
MD	32.00			317961	0	6995	X
DR DAVID STAUB
MD	20.00			257294	0	6337	X
DR LINDA PETERSON
MD	24.00			153696	0	6291	X
DR JAMES MCCABE
MD	32.00			222229	0	10033	X

Field	Value	IRS element (for citing)
Total Reportable Comp From Org	1604247	TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs	0	TotalReportableCompFrmRltdOrgs
Total Other Compensation	60347	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	176133	Compensation

Field	Value	IRS element (for citing)
Number Of Contractors GT100 K	1	NumberOfContractorsGT100K
Government Grants	45340	GovernmentGrants
All Other Contributions	43000	AllOtherContributions
Total Contributions	88340	TotalContributions

Program Service Revenue ProgramServiceRevenue (3 entries)

DescriptionDescription	Business CodeBusinessCode	Total Revenue ColumnTotalRevenueColumn	Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome
PATIENT SERVICE REV	622110	12500643	12500643
MISC REV	900099	62397	62397
CAFETERIA REV	900099	23113	23113

Field	Value	IRS element (for citing)
Total Program Service Revenue	12586153	TotalProgramServiceRevenue

Investment Income InvestmentIncome

Field	Value	IRS element (for citing)
Total Revenue Column	3989	TotalRevenueColumn
Exclusion	$3,989	ExclusionAmount

Gross Rents GrossRents

Field	Value	IRS element (for citing)
Real	17309	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	17309	Real

Net Rental Income Or Loss NetRentalIncomeOrLoss

Field	Value	IRS element (for citing)
Total Revenue Column	17309	TotalRevenueColumn
Exclusion	$17,309	ExclusionAmount

Gross Amount Sales Assets GrossAmountSalesAssets

Field	Value	IRS element (for citing)
Securities	475000	Securities

Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses

Field	Value	IRS element (for citing)
Securities	475000	Securities

Gain Or Loss GainOrLoss

Field	Value	IRS element (for citing)
Securities	0	Securities

Net Gain Or Loss Investments NetGainOrLossInvestments

Field	Value	IRS element (for citing)
Total Revenue Column	0	TotalRevenueColumn

Total Revenue TotalRevenue

Field	Value	IRS element (for citing)
Total Revenue Column	12695791	TotalRevenueColumn
Related Or Exempt Function Income	12586153	RelatedOrExemptFunctionIncome
Unrelated Business Revenue	0	UnrelatedBusinessRevenue
Exclusion	$21,298	ExclusionAmount

Grants To Domestic Orgs GrantsToDomesticOrgs

Field	Value	IRS element (for citing)
Total	2000	Total
Program Services	2000	ProgramServices

Comp Current Officers Directors CompCurrentOfficersDirectors

Field	Value	IRS element (for citing)
Total	216367	Total
Management And General	216367	ManagementAndGeneral

Other Salaries And Wages OtherSalariesAndWages

Field	Value	IRS element (for citing)
Total	5178988	Total
Program Services	4745817	ProgramServices
Management And General	433171	ManagementAndGeneral

Pension Plan Contributions PensionPlanContributions

Field	Value	IRS element (for citing)
Total	115247	Total
Program Services	101820	ProgramServices
Management And General	13427	ManagementAndGeneral

Other Employee Benefits OtherEmployeeBenefits

Field	Value	IRS element (for citing)
Total	415194	Total
Program Services	361460	ProgramServices
Management And General	53734	ManagementAndGeneral

Payroll Taxes PayrollTaxes

Field	Value	IRS element (for citing)
Total	635817	Total
Program Services	561741	ProgramServices
Management And General	74076	ManagementAndGeneral

Fees For Services Legal FeesForServicesLegal

Field	Value	IRS element (for citing)
Total	90	Total
Management And General	90	ManagementAndGeneral

Fees For Services Accounting FeesForServicesAccounting

Field	Value	IRS element (for citing)
Total	38350	Total
Management And General	38350	ManagementAndGeneral

Fees For Services Other FeesForServicesOther

Field	Value	IRS element (for citing)
Total	725168	Total
Program Services	692357	ProgramServices
Management And General	32811	ManagementAndGeneral

Advertising Advertising

Field	Value	IRS element (for citing)
Total	33726	Total
Management And General	33726	ManagementAndGeneral

Office Expenses OfficeExpenses

Field	Value	IRS element (for citing)
Total	473749	Total
Program Services	358650	ProgramServices
Management And General	115099	ManagementAndGeneral

Information Technology InformationTechnology

Field	Value	IRS element (for citing)
Total	343639	Total
Management And General	343639	ManagementAndGeneral

Occupancy Occupancy

Field	Value	IRS element (for citing)
Total	141270	Total
Program Services	141270	ProgramServices

Travel Travel

Field	Value	IRS element (for citing)
Total	30982	Total
Program Services	25339	ProgramServices
Management And General	5643	ManagementAndGeneral

Conferences Meetings ConferencesMeetings

Field	Value	IRS element (for citing)
Total	126620	Total
Program Services	108678	ProgramServices
Management And General	17942	ManagementAndGeneral

Depreciation Depletion DepreciationDepletion

Field	Value	IRS element (for citing)
Total	411680	Total
Program Services	411680	ProgramServices

Insurance Insurance

Field	Value	IRS element (for citing)
Total	143886	Total
Management And General	143886	ManagementAndGeneral

Other Expenses OtherExpenses (4 entries)

DescriptionDescription	TotalTotal	Program ServicesProgramServices	Management And GeneralManagementAndGeneral
MEDICAL SUPPLIES	1904184	1904184
BAD DEBT	678284	678284
EQUIP RENTAL & MAINT	430813	419392	11421
LICENSE AND PERMIT	15836	12399	3437

All Other Expenses AllOtherExpenses

Field	Value	IRS element (for citing)
Total	25440	Total
Program Services	3210	ProgramServices
Management And General	22230	ManagementAndGeneral

Total Functional Expenses TotalFunctionalExpenses

Field	Value	IRS element (for citing)
Total	12087330	Total
Program Services	10528281	ProgramServices
Management And General	1559049	ManagementAndGeneral
Fundraising	0	Fundraising

Savings And Temp Cash Investments SavingsAndTempCashInvestments

Field	Value	IRS element (for citing)
BOY	864525	BOY
EOY	1311738	EOY

Accounts Receivable AccountsReceivable

Field	Value	IRS element (for citing)
BOY	2569868	BOY
EOY	3633857	EOY

Inventories For Sale Or Use InventoriesForSaleOrUse

Field	Value	IRS element (for citing)
BOY	143717	BOY
EOY	187288	EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

Field	Value	IRS element (for citing)
BOY	88601	BOY
EOY	119729	EOY

Field	Value	IRS element (for citing)
Land Buildings Equipment Basis	8073319	LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec	5585898	LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

Field	Value	IRS element (for citing)
BOY	2738837	BOY
EOY	2487421	EOY

Total Assets TotalAssets

Field	Value	IRS element (for citing)
BOY	6405548	BOY
EOY	7740033	EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

Field	Value	IRS element (for citing)
BOY	525693	BOY
EOY	1258793	EOY

Deferred Revenue DeferredRevenue

Field	Value	IRS element (for citing)
BOY	7076	BOY

Total Liabilities TotalLiabilities

Field	Value	IRS element (for citing)
BOY	532769	BOY
EOY	1258793	EOY

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

Unrestricted Net Assets UnrestrictedNetAssets

Field	Value	IRS element (for citing)
BOY	5872779	BOY
EOY	6481240	EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

Field	Value	IRS element (for citing)
BOY	5872779	BOY
EOY	6481240	EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

Field	Value	IRS element (for citing)
BOY	6405548	BOY
EOY	7740033	EOY

Field	Value	IRS element (for citing)
Reconcilation Revenue Expenses	608461	ReconcilationRevenueExpenses
Reconcilation Other Changes	0	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

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	3712170	OtherCostOrOtherBasis
Depreciation	2468290	Depreciation
Book Value	1243880	BookValue

Equipment Equipment

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	4126400	OtherCostOrOtherBasis
Depreciation	3016974	Depreciation
Book Value	1109426	BookValue

Other Land Buildings OtherLandBuildings

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	221193	OtherCostOrOtherBasis
Depreciation	100634	Depreciation
Book Value	120559	BookValue

Field	Value	IRS element (for citing)
Total Of Book Value Land Buildings	2487421	TotalOfBookValueLandBuildings
Total Revenue	12695791	TotalRevenue
Total Expenses	12087330	TotalExpenses
Excess Or Deficit For Year	608461	ExcessOrDeficitForYear
Excess Or Deficit Per FS	608461	ExcessOrDeficitPerFS
Tot Revenue Etc Audited Fincl Stmt	12695791	TotRevenueEtcAuditedFinclStmt
Revenue Not Rptd F990	0	RevenueNotRptdF990
Revenue Subtotal	12695791	RevenueSubtotal
Revenue Not Rptd On Fin Stmt	0	RevenueNotRptdOnFinStmt
Total Revenue Per Form990	12695791	TotalRevenuePerForm990
Tot Expenses Etc Audited Fincl Stmt	12087330	TotExpensesEtcAuditedFinclStmt
Expenses Not Rptd F990	0	ExpensesNotRptdF990
Expenses Subtotal	12087330	ExpensesSubtotal
Expenses Not Rptd On Fin Stmt	0	ExpensesNotRptdOnFinStmt
Total Expenses Per Form990	12087330	TotalExpensesPerForm990

Form990 Schedule D Part XIV Form990ScheduleDPartXIV

Field	Value	IRS element (for citing)
Identifier	DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48:	Identifier
Return Reference	PART X:	ReturnReference
Explanation	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.	Explanation

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	53569	TotalCommunityBenefitExpense
Net Community Benefit Expense	53569	NetCommunityBenefitExpense
Percent Of Total Expense	0.00470	PercentOfTotalExpense

Unreimbursed Medicaid UnreimbursedMedicaid

Field	Value	IRS element (for citing)
Total Community Benefit Expense	1253402	TotalCommunityBenefitExpense
Direct Offsetting Revenue	1239257	DirectOffsettingRevenue
Net Community Benefit Expense	14145	NetCommunityBenefitExpense
Percent Of Total Expense	0.00120	PercentOfTotalExpense

Total Charity Care TotalCharityCare

Field	Value	IRS element (for citing)
Total Community Benefit Expense	1306971	TotalCommunityBenefitExpense
Direct Offsetting Revenue	1239257	DirectOffsettingRevenue
Net Community Benefit Expense	67714	NetCommunityBenefitExpense
Percent Of Total Expense	0.00590	PercentOfTotalExpense

Community Health Services CommunityHealthServices

Field	Value	IRS element (for citing)
Total Community Benefit Expense	412	TotalCommunityBenefitExpense
Net Community Benefit Expense	412	NetCommunityBenefitExpense
Percent Of Total Expense	0.00000	PercentOfTotalExpense

Health Professions Education HealthProfessionsEducation

Field	Value	IRS element (for citing)
Total Community Benefit Expense	1000	TotalCommunityBenefitExpense
Net Community Benefit Expense	1000	NetCommunityBenefitExpense
Percent Of Total Expense	0.00010	PercentOfTotalExpense

Subsidized Health Services SubsidizedHealthServices

Field	Value	IRS element (for citing)
Total Community Benefit Expense	2552921	TotalCommunityBenefitExpense
Direct Offsetting Revenue	1344425	DirectOffsettingRevenue
Net Community Benefit Expense	1208496	NetCommunityBenefitExpense
Percent Of Total Expense	0.10590	PercentOfTotalExpense

Cash And In Kind Contributions CashAndInKindContributions

Field	Value	IRS element (for citing)
Total Community Benefit Expense	2000	TotalCommunityBenefitExpense
Net Community Benefit Expense	2000	NetCommunityBenefitExpense
Percent Of Total Expense	0.00020	PercentOfTotalExpense

Total Other Benefits TotalOtherBenefits

Field	Value	IRS element (for citing)
Total Community Benefit Expense	2556333	TotalCommunityBenefitExpense
Direct Offsetting Revenue	1344425	DirectOffsettingRevenue
Net Community Benefit Expense	1211908	NetCommunityBenefitExpense
Percent Of Total Expense	0.10620	PercentOfTotalExpense

Total Community Benefits TotalCommunityBenefits

Field	Value	IRS element (for citing)
Total Community Benefit Expense	3863304	TotalCommunityBenefitExpense
Direct Offsetting Revenue	2583682	DirectOffsettingRevenue
Net Community Benefit Expense	1279622	NetCommunityBenefitExpense
Percent Of Total Expense	0.11210	PercentOfTotalExpense

Field	Value	IRS element (for citing)
Bad Debt Expense Reported	0	BadDebtExpenseReported
Bad Debt Expense	$678,284	BadDebtExpenseAmount
Amount Attributable To	339142	AmountAttributableTo
Amount Reimbursed By Medicare	2856841	AmountReimbursedByMedicare
Cost Of Care Reimbursed By Medicare	2809950	CostOfCareReimbursedByMedicare
Medicare Surplus Or Shortfall	46891	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
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
Nondiscrim Emergency Care Policy	1	NondiscrimEmergencyCarePolicy
Used Other Method	X	UsedOtherMethod
Amounts Generally Billed	1	AmountsGenerallyBilled
Gross Charges	1	GrossCharges

Form990 Schedule H Part V Section C Form990ScheduleHPartVSectionC

Field	Value	IRS element (for citing)
Number Of Other Facilities	3	NumberOfOtherFacilities

Other Facilities OtherFacilities (3 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

Form990 Schedule H Part VI Form990ScheduleHPartVI (17 entries)

ExplanationExplanation	IdentifierIdentifier	Return ReferenceReturnReference
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: LINE 7A WAS DETERMINED BY MULTIPLYING THE RATIO OF COST TO GROSS CHARGES FOR THE HOSPITAL BY THE GROSS UNCOMPENSATED CHARGES ASSOCIATED WITH PROVIDING CHARITY CARE TO ITS PATIENTS. 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, LINE 7G: THE EXPENSES OF THE RURAL HEALTH CLINIC TOTAL $2,366,722.
PART I, L7 COL(F): BAD DEBT EXPENSE OF $678,284 WAS SUBTRACTED FROM TOTAL OPERATING EXPENSE.
PART II: NONE
PART III, LINE 4: A) 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: THE CARRYING AMOUNT OF PATIENT RECEIVABLES IS REDUCED BY A VALUATION ALLOWANCE THAT REFLECTS MANAGEMENT'S BEST ESTIMATE OF AMOUNTS THAT WILL NOT BE COLLECTED FROM PATIENTS AND THIRD-PARTY PAYORS. MANAGEMENT REVIEWS PATIENT RECEIVABLES BY PAYOR CLASS AND APPLIES PERCENTAGES TO DETERMINE ESTIMATED AMOUNTS THAT WILL NOT BE COLLECTED FROM THIRD PARTIES UNDER CONTRACTUAL AGREEMENTS AND AMOUNTS THAT WILL NOT BE COLLECTED FROM PATIENTS DUE TO BAD DEBTS. MANAGEMENT CONSIDERS HISTORICAL WRITE OFF AND RECOVERY INFORMATION IN DETERMINING THE ESTIMATED BAD DEBT PROVISION.
PART III, LINE 8: MEDICARE ALLOWABLE COST OF CARE WAS CALCULATED FROM THE MEDICARE COST REPORT FOR THE PERIOD ENDING 12/31/2011. THE MEDICARE COST REPORT WAS FILED IN ACCORDANCE WITH THE AUDITED FINANCIAL STATEMENTS.
PART V, SECTION B, LINE 13G: 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 19D: ALL PATIENTS ARE CHARGED GROSS CHARGES INITIALLY. AS OF YEAR END, A POLICY HAD NOT BEEN APPROVED BY MANAGEMENT. HOWEVER, MANAGEMENT HAS ADOPTED AND APPROVED THE PROSPECTIVE METHOD TO DETERMINE MAXIMUM AMOUNTS THAT CAN BE CHARGED TO FAP-ELIGIBLE INDIVIDUALS.	COTEAU DES PRAIRIES HOSPITAL & CLINIC
PART V, SECTION B, LINE 20: ALL PATIENTS ARE CHARGED GROSS CHARGES INITIALLY. AS OF YEAR END, A POLICY HAD NOT BEEN APPROVED BY MANAGEMENT. HOWEVER, MANAGEMENT HAS ADOPTED AND APPROVED THE PROSPECTIVE METHOD TO DETERMINE MAXIMUM AMOUNTS THAT CAN BE CHARGED TO FAP-ELIGIBLE INDIVIDUALS.	COTEAU DES PRAIRIES HOSPITAL & CLINIC
PART V, SECTION B, LINE 21: ALL PATIENTS ARE CHARGED GROSS CHARGES INITIALLY. AS OF YEAR END, A POLICY HAD NOT BEEN APPROVED BY MANAGEMENT. HOWEVER, MANAGEMENT HAS ADOPTED AND APPROVED THE PROSPECTIVE METHOD TO DETERMINE MAXIMUM AMOUNTS THAT CAN BE CHARGED TO FAP-ELIGIBLE INDIVIDUALS.	COTEAU DES PRAIRIES HOSPITAL & CLINIC
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.		PART V, SECTION B, LINE 14:
PART VI, LINE 2: THE PRIORITY OF CDPH IS TO PROMOTE THE HEALTH OF SISSETON AND ALSO THE SURROUNDING RURAL COMMUNITIES. THROUGH OUTREACH TO OUR COMMUNITY, INCLUDING OUR 2 OUTREACH CLINICS, THE HOME HEALTH DEPARTMENT, AND THROUGH WORKING WITH LOCAL, STATE AND FEDERAL DEPARTMENTS, CDPH DETERMINES THE HEALTH CARE NEEDS OF THE COMMUNITY, AND WORKS TO ENSURE THE SERVICES AND EVENTS PROVIDED TO THE COMMUNITY ARE BENEFICIAL AND IN ACCORDANCE WITH THE COMMUNITY'S HEALTH CARE NEEDS.
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 AND ALSO IN THE MAIN ENTRANCE/ADMISSION AREAS FOR EACH OF THE CLINICS. 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. ROBERTS COUNTY HAS AN ESTIMATED POPULATION OF 10,286 IN 2011 - OF THAT POPULATION 17.1% ARE 65 YEARS OR OLDER; 28.6% ARE 18 YEARS AND YOUNGER; 34.6% ARE OF NATIVE AMERICAN HERITAGE. ROBERTS COUNTY'S TOTAL POPULATION INCLUDES THE FOLLOWING STATISTICS: 14% HAVE ATTENDED 9TH THRU 12TH GRADE WITHOUT A DIPLOMA; AVERAGE HOUSEHOLD INCOME OF $37,708 OR LESS, USING 2.62 PERSONS PER HOUSEHOLD; AND 20.0% HOLD POVERTY STATUS FOR FAMILIES WITH CHILDREN UNDER 18 YEARS. LIVING IN A SMALL RURAL COMMUNITY THE MEAN TRAVEL TIME TO WORK IN MINUTES IS AN AVERAGE OF 17.6 MINUTES.
PART VI, LINE 5: CDPH IS A SOLE COMMUNITY PROVIDER WITH AN 11 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 (5 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
DR STANLEY GALLAGHER
460411	0	0	0	0	0	0	0	6981	0	467392	0	0	0
DR JUDY BEUMER
317961	0	0	0	0	0	0	0	6995	0	324956	0	0	0
DR DAVID STAUB
257294	0	0	0	0	0	0	0	6337	0	263631	0	0	0
DR LINDA PETERSON
153696	0	0	0	0	0	0	0	6291	0	159987	0	0	0
DR JAMES MCCABE
222229	0	0	0	0	0	0	0	10033	0	232262	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 O IRS990ScheduleO

General Explanation GeneralExplanation (6 entries)

Return ReferenceReturnReference	ExplanationExplanation
FORM 990, PART VI, SECTION A, LINE 4	THE BY-LAWS WERE AMENDED TO STATE THAT THE ANNUAL MEETING WILL BE HELD FOLLOWING THE REGULAR SCHEDULED APRIL MEETING (PREVIOUSLY WAS TO BE HELD WITHIN 90 DAYS OF YEAR-END).
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. AFTER HIS REVIEW, THE 990 IS PROVIDED TO EACH BOARD MEMBER. THE DIRECTOR OF FINANCE PRESENTS THE 990 TO THE BOARD OF DIRECTORS AT THE MEETING HELD PRIOR TO ITS FILING IF SO REQUESTED BY ANY BOARD MEMBER. WHETHER PRESENTED IN A BOARD MEETING OR NOT, THE 990 IS NOT FILED UNTIL EACH BOARD MEMBER HAS BEEN GIVEN A COPY OF IT AND GIVEN AMPLE TIME TO REVIEW IT.
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.