MOBRIDGE REGIONAL HOSPITAL: Form 990, tax year 2009

View the entire original 990 at ProPublica ↗

Organization
MOBRIDGE REGIONAL HOSPITAL (EIN 46-0255944)
Tax period
2009-10-01 to 2010-09-30
Filed
2011-08-12
IRS object ID
201142289349300994
Schema version
2009v1.7
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

FieldValueIRS element (for citing)
Timestamp2011-08-12T13:39:29-05:00Timestamp
Tax Period End Date2010-09-30TaxPeriodEndDate

Preparer Firm PreparerFirm

Preparer Firm Business Name PreparerFirmBusinessName

FieldValueIRS element (for citing)
Business Name Line1EIDE BAILLY LLPBusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

FieldValueIRS element (for citing)
Address Line1200 EAST 10TH ST PO BOX 5125AddressLine1
CitySIOUX FALLSCity
StateSDState
ZIP Code571175125ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnType
Tax Period Begin Date2009-10-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN460255944EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1Mobridge Regional HospitalBusinessNameLine1
FieldValueIRS element (for citing)
Name ControlMOBRNameControl
Phone6058453692Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line11401 10th Ave WAddressLine1
CityMobridgeCity
StateSDState
ZIP Code57601ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NameAngelia SvihovecName
TitleCEOTitle
Phone6058453692Phone
Date Signed2011-08-12DateSigned
Authorize Third Party1AuthorizeThirdParty

Preparer Preparer

FieldValueIRS element (for citing)
NameLaurie HansonName
Phone6053391999Phone
Date Prepared2011-08-12DatePrepared
FieldValueIRS element (for citing)
Tax Year2009TaxYear
Build TS2016-02-24 21:20:13ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Name Of Principal Officer PersonAngelia SvihovecNameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line11401 10th Ave WAddressLine1
CityMobridgeCity
StateSDState
ZIP Code57601ZIPCode
FieldValueIRS element (for citing)
Gross Receipts15444894GrossReceipts
Group Return For Affiliates0GroupReturnForAffiliates
Organization501cXOrganization501c
Web Sitewww.mobridgehospital.orgWebSite
Type Of Organization CorporationXTypeOfOrganizationCorporation
Year Formation1959YearFormation
State Legal DomicileSDStateLegalDomicile
Activity Or Mission DescriptionProviding healthcare to people throughout the region.ActivityOrMissionDescription
Nbr Voting Members Governing Body12NbrVotingMembersGoverningBody
Nbr Independent Voting Members10NbrIndependentVotingMembers
Total Nbr Employees184TotalNbrEmployees
Total Nbr Volunteers150TotalNbrVolunteers
Total Gross UBI0TotalGrossUBI
Net Unrelated Business Txbl Income0NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year166965ContributionsGrantsPriorYear
Contributions Grants Current Year1066313ContributionsGrantsCurrentYear
Program Service Revenue Prior Year13359976ProgramServiceRevenuePriorYear
Program Service Revenue CY14215894ProgramServiceRevenueCY
Investment Income Prior Year58695InvestmentIncomePriorYear
Investment Income Current Year77629InvestmentIncomeCurrentYear
Other Revenue Prior Year62175OtherRevenuePriorYear
Other Revenue Current Year85058OtherRevenueCurrentYear
Total Revenue Prior Year13647811TotalRevenuePriorYear
Total Revenue Current Year15444894TotalRevenueCurrentYear
Grants And Similar Amnts CY0GrantsAndSimilarAmntsCY
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Prior Year6742279SalariesEtcPriorYear
Salaries Etc Current Year7344583SalariesEtcCurrentYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year0TotalFundrsngExpCurrentYear
Other Expense Prior Year5820653OtherExpensePriorYear
Other Expenses Current Year6282650OtherExpensesCurrentYear
Total Expenses Prior Year12562932TotalExpensesPriorYear
Total Expenses Current Year13627233TotalExpensesCurrentYear
Revenues Less Expenses Prior Year1084879RevenuesLessExpensesPriorYear
Revenues Less Expenses CY1817661RevenuesLessExpensesCY
Total Assets BOY15010699TotalAssetsBOY
Total Assets EOY17134975TotalAssetsEOY
Total Liabilities BOY6929716TotalLiabilitiesBOY
Total Liabilities EOY7236331TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY8080983NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY9898644NetAssetsOrFundBalancesEOY
Mission DescriptionThe mission of Mobridge Regional Hospital is to provide high quality healthcare services in a compassionate and professional manner for people throughout the region.MissionDescription
Significant New Program Services0SignificantNewProgramServices
Significant Change0SignificantChange
Expense12302945Expense
Revenue14215894Revenue
DescriptionMobridge Regional Hospital (MRH) provides healthcare services to persons throughout the region. During the fiscal year ended September 30, 2010, the hospital had: 1,761 Patient Days 924 Acute Care Days30,911 Outpatient Visits 5,730 Assisted Living Days (Prairie Sunset Village)MRH's charity care program is available to both new and established patients. The charity care policy covers all medically necessary services provided by the institution that are ordered by physicians. The policy does not cover services provided by non-institution healthcare providers, patient convenience items, or insurance co-payments for Medicaid, Medicare or other needs-based programs. MRH's charity care program is available to all patients who indicate an inability to pay for all or a portion of their outstanding hospital bill. In order to be eligible, patients must complete an application and provide all required documentation.Description
Total Program Service Expense12302945TotalProgramServiceExpense
Described In501 C31DescribedIn501C3
Schedule B Required1ScheduleBRequired
Political Activities0PoliticalActivities
Lobbying Activities0LobbyingActivities
Donor Advised Funds0DonorAdvisedFunds
Conservation Easements0ConservationEasements
Collections Of Art0CollectionsOfArt
Credit Counseling0CreditCounseling
Term Or Permanent Endowments0TermOrPermanentEndowments
Balance Sheet Amounts Reported1BalanceSheetAmountsReported
Independent Audit Financial Stmt1IndependentAuditFinancialStmt
Consolidated Audit Financial Stmt0ConsolidatedAuditFinancialStmt
School0School
Foreign Office0ForeignOffice
Foreign Activities0ForeignActivities
More Than5000 K To Organizations0MoreThan5000KToOrganizations
More Than5000 K To Individuals0MoreThan5000KToIndividuals
Professional Fundraising0ProfessionalFundraising
Fundraising Activities0FundraisingActivities
Gaming0Gaming
Hospital1Hospital
Grants To Organizations0GrantsToOrganizations
Grants To Individuals0GrantsToIndividuals
Schedule J Required1ScheduleJRequired
Tax Exempt Bonds1TaxExemptBonds
Invest Tax Exempt Bonds0InvestTaxExemptBonds
Escrow Account0EscrowAccount
On Behalf Of Issuer0OnBehalfOfIssuer
Excess Benefit Transaction0ExcessBenefitTransaction
Prior Excess Benefit Transaction0PriorExcessBenefitTransaction
Loan To Officer Or DQP0LoanToOfficerOrDQP
Grant To Related Person0GrantToRelatedPerson
Bsnss Rltnshp With Organization0BsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family Member0BsnssRltnshpThruFamilyMember
Officer Entity With Bsnss Rltnshp0OfficerEntityWithBsnssRltnshp
Deductible Non Cash Contributions0DeductibleNonCashContributions
Deductible Contributions Of Art0DeductibleContributionsOfArt
Terminated0Terminated
Partial Liquidation0PartialLiquidation
Disregarded Entity0DisregardedEntity
Related Entity0RelatedEntity
Related Org Controlled Entity0RelatedOrgControlledEntity
Transfers To Exempt Non Chrtbl Org0TransfersToExemptNonChrtblOrg
Activities Conducted Partnership0ActivitiesConductedPartnership
Schedule O Required1ScheduleORequired
Number Forms Transmitted With109615NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Number Of Employees184NumberOfEmployees
Employment Tax Returns Filed1EmploymentTaxReturnsFiled
Unrelated Business Income0UnrelatedBusinessIncome
Foreign Financial Account0ForeignFinancialAccount
Prohibited Tax Shelter Trans0ProhibitedTaxShelterTrans
Taxable Party Notification0TaxablePartyNotification
Non Deductible Contributions0NonDeductibleContributions
Quid Pro Quo Contributions0QuidProQuoContributions
Form8282 Property Disposed Of0Form8282PropertyDisposedOf
Nbr Voting Governing Body Members12NbrVotingGoverningBodyMembers
Number Independent Voting Members10NumberIndependentVotingMembers
Family Or Business Relationship0FamilyOrBusinessRelationship
Delegation Of Management Duties1DelegationOfManagementDuties
Changes To Organizing Docs0ChangesToOrganizingDocs
Material Diversion Or Misuse0MaterialDiversionOrMisuse
Members Or Stockholders1MembersOrStockholders
Election Of Board Members1ElectionOfBoardMembers
Decisions Subject To Approval0DecisionsSubjectToApproval
Minutes Of Governing Body1MinutesOfGoverningBody
Minutes Of Committees0MinutesOfCommittees
Officer Mailing Address0OfficerMailingAddress
Local Chapters0LocalChapters
Form990 Provided To Governing Body0Form990ProvidedToGoverningBody
Conflict Of Interest Policy1ConflictOfInterestPolicy
Annual Disclosure Covered Persons1AnnualDisclosureCoveredPersons
Regular Monitoring Enforcement1RegularMonitoringEnforcement
Whistleblower Policy1WhistleblowerPolicy
Document Retention Policy1DocumentRetentionPolicy
Compensation Process CEO1CompensationProcessCEO
Compensation Process Other1CompensationProcessOther
Investment In Joint Venture0InvestmentInJointVenture
Upon RequestXUponRequest

The Books Are In Care Of TheBooksAreInCareOf

Name Business NameBusiness

FieldValueIRS element (for citing)
Business Name Line1Renae TisdallBusinessNameLine1
FieldValueIRS element (for citing)
Telephone Number6058458164TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line1PO Box 580AddressLine1
CityMobridgeCity
StateSDState
ZIP Code57601ZIPCode

Form990 Part VII Section A Form990PartVIISectionA (20 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekIndividual Trustee Or DirectorIndividualTrusteeOrDirectorOfficerOfficerReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensationKey EmployeeKeyEmployeeHighest Compensated EmployeeHighestCompensatedEmployee
Dennis Schnabel
Chairman1.00XX000
Delphine Steuck
Vice Chair1.00XX000
Bill Bachmeier
Treasurer1.00XX000
Heidi Roshau
Secretary1.00XX000
Jake Kraft
Director1.00X000
Wally Schott
Director1.00X000
Doug Scott
Director1.00X000
Donald Paulson
Director1.00X000
Benjamin Stoick
Director1.00X000
Dr Leonard Linde
Director1.00X000
Dr Travis Henderson
Physician/Director40.00X206133018879X
Dr Robert Marciano
Physician/Director40.00X228767016090X
Chad Thue
Director (thru June 2010)1.00X000
Angelia Svihovec
CEO40.00X132861015775
Renae Tisdall
CFO40.00X59326013487
Dr Bela Csaki
Physician40.00258291017137X
Dr Colette Ducheneaux
Physician40.00193694013892X
Dr Kenric Malmberg
Physician40.00188367014049X
Jim Curran
CRNA40.00177380014363X
Debbie Smith
CRNA40.0018648004447X
FieldValueIRS element (for citing)
Total Reportable Comp From Org1631299TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs0TotalReportableCompFrmRltdOrgs
Total Other Compensation128119TotalOtherCompensation
Number Individuals GT100 K8NumberIndividualsGT100K
Formers Listed0FormersListed
Total Comp GT150 K1TotalCompGT150K
Compensation From Other Sources1CompensationFromOtherSources

Contractor Compensation ContractorCompensation

Name Of Contractor NameOfContractor

Name Business NameBusiness

FieldValueIRS element (for citing)
Business Name Line1St Alexius Medical CenterBusinessNameLine1

Address Of Contractor AddressOfContractor

Address US AddressUS

FieldValueIRS element (for citing)
Address Line1900 East BroadwayAddressLine1
CityBismarckCity
StateNDState
ZIP Code58506ZIPCode
FieldValueIRS element (for citing)
Description Of ServicesIT Services, CEO Salary, Supplies, TelemDescriptionOfServices
Compensation241560Compensation
FieldValueIRS element (for citing)
Number Of Contractors GT100 K1NumberOfContractorsGT100K
Government Grants249762GovernmentGrants
All Other Contributions816551AllOtherContributions
Total Contributions1066313TotalContributions

Program Service Revenue ProgramServiceRevenue (4 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnRelated Or Exempt Function IncomeRelatedOrExemptFunctionIncome
Patient Service Rev6221101358091313580913
Assisted Living Rev623110497080497080
Ancillary Charges9000998853488534
Chng in Int-Mobridge H9000994936749367
FieldValueIRS element (for citing)
Total Program Service Revenue14215894TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column76629TotalRevenueColumn
Exclusion$76,629ExclusionAmount

Gross Rents GrossRents

FieldValueIRS element (for citing)
Real85058Real

Rental Income Or Loss RentalIncomeOrLoss

FieldValueIRS element (for citing)
Real85058Real

Net Rental Income Or Loss NetRentalIncomeOrLoss

FieldValueIRS element (for citing)
Total Revenue Column85058TotalRevenueColumn
Exclusion$85,058ExclusionAmount

Gross Amount Sales Assets GrossAmountSalesAssets

FieldValueIRS element (for citing)
Other1000Other

Gain Or Loss GainOrLoss

FieldValueIRS element (for citing)
Other1000Other

Net Gain Or Loss Investments NetGainOrLossInvestments

FieldValueIRS element (for citing)
Total Revenue Column1000TotalRevenueColumn
Exclusion$1,000ExclusionAmount

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column15444894TotalRevenueColumn
Related Or Exempt Function Income14215894RelatedOrExemptFunctionIncome
Unrelated Business Revenue0UnrelatedBusinessRevenue
Exclusion$162,687ExclusionAmount

Comp Current Officers Directors CompCurrentOfficersDirectors

FieldValueIRS element (for citing)
Total795081Total
Program Services537646ProgramServices
Management And General257435ManagementAndGeneral

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total5895476Total
Program Services5492664ProgramServices
Management And General402812ManagementAndGeneral

Pension Plan Contributions PensionPlanContributions

FieldValueIRS element (for citing)
Total206556Total
Program Services189525ProgramServices
Management And General17031ManagementAndGeneral

Payroll Taxes PayrollTaxes

FieldValueIRS element (for citing)
Total447470Total
Program Services397635ProgramServices
Management And General49835ManagementAndGeneral

Fees For Services Legal FeesForServicesLegal

FieldValueIRS element (for citing)
Total11177Total
Management And General11177ManagementAndGeneral

Fees For Services Accounting FeesForServicesAccounting

FieldValueIRS element (for citing)
Total33561Total
Management And General33561ManagementAndGeneral

Fees For Services Other FeesForServicesOther

FieldValueIRS element (for citing)
Total702433Total
Program Services504854ProgramServices
Management And General197579ManagementAndGeneral

Advertising Advertising

FieldValueIRS element (for citing)
Total63505Total
Program Services6449ProgramServices
Management And General57056ManagementAndGeneral

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total153193Total
Program Services44701ProgramServices
Management And General108492ManagementAndGeneral

Information Technology InformationTechnology

FieldValueIRS element (for citing)
Total43107Total
Program Services19215ProgramServices
Management And General23892ManagementAndGeneral

Occupancy Occupancy

FieldValueIRS element (for citing)
Total304616Total
Program Services301006ProgramServices
Management And General3610ManagementAndGeneral

Travel Travel

FieldValueIRS element (for citing)
Total29159Total
Program Services29159ProgramServices

Conferences Meetings ConferencesMeetings

FieldValueIRS element (for citing)
Total48349Total
Program Services40013ProgramServices
Management And General8336ManagementAndGeneral

Interest Interest

FieldValueIRS element (for citing)
Total263384Total
Program Services263384ProgramServices

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total926117Total
Program Services926117ProgramServices

Insurance Insurance

FieldValueIRS element (for citing)
Total921755Total
Program Services921755ProgramServices

Other Expenses OtherExpenses (5 entries)

DescriptionDescriptionTotalTotalProgram ServicesProgramServicesManagement And GeneralManagementAndGeneral
Medical Supplies11987001198700
Bad Debt903664903664
Repairs and Maintenance32918328688542298
Minor Equipment1493541476791675
Equipment Lease and Ren942123909355119

All Other Expenses AllOtherExpenses

FieldValueIRS element (for citing)
Total107181Total
Program Services52801ProgramServices
Management And General54380ManagementAndGeneral

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total13627233Total
Program Services12302945ProgramServices
Management And General1324288ManagementAndGeneral
Fundraising0Fundraising

Savings And Temp Cash Investments SavingsAndTempCashInvestments

FieldValueIRS element (for citing)
BOY4483612BOY
EOY5476524EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY2073898BOY
EOY2207030EOY

Inventories For Sale Or Use InventoriesForSaleOrUse

FieldValueIRS element (for citing)
BOY403695BOY
EOY467670EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY85834BOY
EOY57774EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis18504397LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec10832212LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY6795319BOY
EOY7672185EOY

Investments Other Securities InvestmentsOtherSecurities

FieldValueIRS element (for citing)
BOY455803BOY
EOY546198EOY

Other Assets Total OtherAssetsTotal

FieldValueIRS element (for citing)
BOY712538BOY
EOY707594EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY15010699BOY
EOY17134975EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY1432549BOY
EOY1774202EOY

Tax Exempt Bond Liabilities TaxExemptBondLiabilities

FieldValueIRS element (for citing)
BOY5335000BOY
EOY5050000EOY

Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp

FieldValueIRS element (for citing)
BOY87950BOY
EOY298103EOY

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
BOY74217BOY
EOY114026EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY6929716BOY
EOY7236331EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY7689344BOY
EOY9284551EOY

Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY391639BOY
EOY614093EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY8080983BOY
EOY9898644EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY15010699BOY
EOY17134975EOY
FieldValueIRS element (for citing)
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or Review0AccountantCompileOrReview
FS Audited1FSAudited
Audit Committee1AuditCommittee
Financial Statement SeparateXFinancialStatementSeparate
Federal Grant Audit Required0FederalGrantAuditRequired

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Hospital170b1 AiiiXHospital170b1Aiii

Schedule B IRS990ScheduleB

Contributor Info ContributorInfo

FieldValueIRS element (for citing)
Contributor NumberRESTRICTEDContributorNumber

Contributor Name Business ContributorNameBusiness

FieldValueIRS element (for citing)
Business Name Line1RESTRICTEDBusinessNameLine1

Contributor Address US ContributorAddressUS

FieldValueIRS element (for citing)
Address Line1RESTRICTEDAddressLine1
Address Line2RESTRICTEDAddressLine2
CityRESTRICTEDCity
StateRESTRICTEDState
ZIP CodeRESTRICTEDZIPCode
FieldValueIRS element (for citing)
Aggregate ContributionsRESTRICTEDAggregateContributions

Schedule D IRS990ScheduleD

Land Land

FieldValueIRS element (for citing)
Other Cost Or Other Basis5575OtherCostOrOtherBasis
Book Value5575BookValue

Buildings Buildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis10527105OtherCostOrOtherBasis
Depreciation5807518Depreciation
Book Value4719587BookValue

Equipment Equipment

FieldValueIRS element (for citing)
Other Cost Or Other Basis7647091OtherCostOrOtherBasis
Depreciation4754483Depreciation
Book Value2892608BookValue

Other Land Buildings OtherLandBuildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis324626OtherCostOrOtherBasis
Depreciation270211Depreciation
Book Value54415BookValue
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings7672185TotalOfBookValueLandBuildings

Other Liabilities OtherLiabilities (2 entries)

DescriptionDescriptionAmountAmount
Premium on Bonds Payable$14,834
Deferred Compensation Plan Payable$99,192
FieldValueIRS element (for citing)
Total Of Amounts114026TotalOfAmounts
Total Revenue15444894TotalRevenue
Total Expenses13627233TotalExpenses
Excess Or Deficit For Year1817661ExcessOrDeficitForYear
Total Adjustments0TotalAdjustments
Excess Or Deficit Per FS1817661ExcessOrDeficitPerFS
Tot Revenue Etc Audited Fincl Stmt15444894TotRevenueEtcAuditedFinclStmt
Revenue Not Rptd F9900RevenueNotRptdF990
Revenue Subtotal15444894RevenueSubtotal
Revenue Not Rptd On Fin Stmt0RevenueNotRptdOnFinStmt
Total Revenue Per Form99015444894TotalRevenuePerForm990
Tot Expenses Etc Audited Fincl Stmt13627233TotExpensesEtcAuditedFinclStmt
Expenses Not Rptd F9900ExpensesNotRptdF990
Expenses Subtotal13627233ExpensesSubtotal
Expenses Not Rptd On Fin Stmt0ExpensesNotRptdOnFinStmt
Total Expenses Per Form99013627233TotalExpensesPerForm990

Form990 Schedule D Part XIV Form990ScheduleDPartXIV

FieldValueIRS element (for citing)
IdentifierPart X:Identifier
Return ReferenceDescription of Uncertain Tax Positions Under FIN 48:ReturnReference
ExplanationMobridge Regional Hospital is organized as a nonprofit corporation as described in Section 501(c)(3) of the Internal Revenue Code and is exempt from federal income taxes on related income pursuant to Section 501(a) of the Code. The Organization has implemented Accounting Standards Codification 740, Income Taxes, (ASC 740). The Organization undergoes an annual analysis of its various tax positions, assessing the likelihood of those positions being upheld upon examination with relevant tax authorities, as defined by ASC 740. For the years ended September 30, 2010 and 2009, the unrecognized tax liability accrual was zero. The Hospital is no longer subject to federal tax examination by tax authorities for years before 2007.Explanation

Schedule H IRS990ScheduleH

FieldValueIRS element (for citing)
Charity Care Policy1CharityCarePolicy
Written Policy1WrittenPolicy
Policy Applied To All HospitalsXPolicyAppliedToAllHospitals
FPG Reference Free Care1FPGReferenceFreeCare
Pcent100XPcent100
FPG Reference Discounted Care1FPGReferenceDiscountedCare
Pcent300XPcent300
Free Disc Care Medically Indigent1FreeDiscCareMedicallyIndigent
Amounts Budgeted For Charity Care1AmountsBudgetedForCharityCare
Expenses Exceeded Budget0ExpensesExceededBudget
Annual Community Benefit Report1AnnualCommunityBenefitReport
Report Publically Available1ReportPublicallyAvailable

Charity Care At Cost CharityCareAtCost

FieldValueIRS element (for citing)
Total Community Benefit Expense76307TotalCommunityBenefitExpense
Net Community Benefit Expense76307NetCommunityBenefitExpense
Percent Of Total Expense0.00560PercentOfTotalExpense

Unreimbursed Medicaid UnreimbursedMedicaid

FieldValueIRS element (for citing)
Total Community Benefit Expense2414888TotalCommunityBenefitExpense
Direct Offsetting Revenue1780090DirectOffsettingRevenue
Net Community Benefit Expense634798NetCommunityBenefitExpense
Percent Of Total Expense0.04660PercentOfTotalExpense

Unreimbursed Costs UnreimbursedCosts

FieldValueIRS element (for citing)
Total Community Benefit Expense419089TotalCommunityBenefitExpense
Direct Offsetting Revenue276758DirectOffsettingRevenue
Net Community Benefit Expense142331NetCommunityBenefitExpense
Percent Of Total Expense0.01040PercentOfTotalExpense

Total Charity Care TotalCharityCare

FieldValueIRS element (for citing)
Total Community Benefit Expense2910284TotalCommunityBenefitExpense
Direct Offsetting Revenue2056848DirectOffsettingRevenue
Net Community Benefit Expense853436NetCommunityBenefitExpense
Percent Of Total Expense0.06260PercentOfTotalExpense

Total Community Benefits TotalCommunityBenefits

FieldValueIRS element (for citing)
Total Community Benefit Expense2910284TotalCommunityBenefitExpense
Direct Offsetting Revenue2056848DirectOffsettingRevenue
Net Community Benefit Expense853436NetCommunityBenefitExpense
Percent Of Total Expense0.06260PercentOfTotalExpense
FieldValueIRS element (for citing)
Bad Debt Expense Reported0BadDebtExpenseReported
Bad Debt Expense$443,576BadDebtExpenseAmount
Amount Attributable To377039AmountAttributableTo
Amount Reimbursed By Medicare5082968AmountReimbursedByMedicare
Cost Of Care Reimbursed By Medicare5032642CostOfCareReimbursedByMedicare
Medicare Surplus Or Shortfall50326MedicareSurplusOrShortfall

Costing Methodology Used CostingMethodologyUsed

FieldValueIRS element (for citing)
OtherXOther
FieldValueIRS element (for citing)
Written Debt Collection Policy1WrittenDebtCollectionPolicy
Provision For Charity Care0ProvisionForCharityCare

Form990 Schedule H Part V Form990ScheduleHPartV (5 entries)

Address Line1Address/AddressLine1CityAddress/CityStateAddress/StateZIP CodeAddress/ZIPCodeLicensed HospitalLicensedHospitalGeneral Medical And SurgicalGeneralMedicalAndSurgicalCritical Access HospitalCriticalAccessHospitalEr24 HoursEr24HoursOtherOther
Mobridge Regional Hospital
1401 10th Avenue WMobridgeSD57601XXXX
Mobridge Medical Clinic
1309 10th Avenue WMobridgeSD57601Provider Based Medical Clinic
West Dakota Health Clinic
906 MainTimber LakeSD57656Provider Based Rural Health Clinic
West River Health Clinic
103 1st Avenue EMcLaughlinSD57642Provider Based Rural Health Clinic
Prairie Sunset Village
1320 W Grand CrossingMobridgeSD57601Assisted Living & Senior Housing

Form990 Schedule H Part VI Form990ScheduleHPartVI

FieldValueIRS element (for citing)
Income Based CriteriaPart I, Line 3c: In addition to using FPG guidelines, MRH utilizes an asset test for free or discounted care along with consideration of the amount of the patient's bill.IncomeBasedCriteria
Costing Method UsedPart I, Line 7: Lines 7a, 7b and 7c were determined using the ratio of patient care costs to charges calculated in IRS Worksheet 2.CostingMethodUsed
Percent Of Total Expense ExplnPart I, Line 7f: Bad debt expense of $903,664 was subtracted from total operating expense.PercentOfTotalExpenseExpln
Bad Debt FootnotePart III, Line 4: a) The cost to charge ratio was calculated on IRS Worksheet 2 for the fiscal year ending 9/30/2010.b) When a payment is received or a discount given on a bad debt account it offsets the current fiscal year bad debt expense through a recovery of bad debt account. c) Bad debt expense attributable to charity care is estimated based on income levels. A large portion of MRH charges are generated by the Native American population and those below the poverty level. Statistics prove that most of the mentioned patients qualify for charity care, thus after review MRH estimates approximately 85% of bad debt at cost is attributable to persons who would qualify for charity care. d) Footnote From Financial Statement: The carrying amount of patient and resident receivables is reduced by a valuation allowance that reflects management's best estimate of amounts that will not be collected from patients, residents and third-party payors. Management reviews patient and resident receivables by payor class and uses aging of individual accounts to estimate amounts that will not be collected from third parties under contractual agreements and amounts that will not be collected from patients and residents due to bad debts. Management considers historical write off and recovery information in determining the estimated bad debt provision. Management also reviews accounts to determine if classification of charity care is appropriate.BadDebtFootnote
Shortfall As Community BenefitPart III, Line 8: Medicare Allowable Cost of Care was calculated from the Medicare Cost Report for fiscal year ending 9/30/10.ShortfallAsCommunityBenefit
General ExplanationPart I, Line 6b: MRH's community benefit information is included in the hospital's annual report, which is mailed out to members and made available in the lobbies of the hospital and clinics.GeneralExplanation
Needs AssessmentPart VI, Line 2: Mobridge Regional Hospital (MRH) is committed to providing high quality healthcare services to all people throughout the region. The facility provides family medicine, internal medicine, OB, ICU, ALS, ambulance service, emergency care, and surgical services to all people who are in need of those services. MRH's management strives to listen to the community needs. If new healthcare needs arise, administration will complete an analysis of cost/benefit for the new service to be offered. MRH's administration believes in being out in the public at events to answer questions that may surface about the facility.NeedsAssessment
Patient Education AssistancePart VI, Line 3: MRH posts its charity care policy, or a summary thereof, and financial assistance contact information in the admissions areas and clinic areas in which eligible patients are likely to be present. The facility provides a copy of the policy, or a summary thereof, and financial assistance contact information to patients with discharge materials. The Patients Account Manager discusses with the patient the availability of various government benefits, such as Medicaid or state programs, and assists the patient with qualification for such programs, where applicable.PatientEducationAssistance
Community InformationPart VI, Line 4: MRH is located in a small rural community in Walworth County, South Dakota, known as Mobridge. According to the 2000 Census, Mobridge has a population of 3,574 people racially comprised of mainly Whites (79.52%) and Native Americans (18.13%). The community borders the Standing Rock Reservation and the Cheyenne River Reservation which accounts for the larger Native American population and relations with Indian Health Services. The median household income of Mobridge is $25,583 and the median family income is $31,026. Roughly 21.6% of the population is below the poverty line. The facility owns and operates clinics in Mobridge, McLaughlin and Timber Lake. The facility serves patients from a five county area (Walworth, Corson, Dewey, Campbell and Potter) and is approximately one hundred miles from another hospital with a higher level of care offered.CommunityInformation
Community Building ActivitiesPart VI, Line 5:CommunityBuildingActivities
Other InformationPart VI, Line 6: The hospital has a Board of Directors comprised of volunteers who reside in the service area. Medical staff privileges are extended to all qualified physicians in the area. All qualified physicians who show an interest must go through a credential review and board approval. Surplus funds, if available, are reinvested in the facilities to improve patient care.MRH is a Certified Level Four Trauma Center under the North Dakota Department of Health. The facility is extremely proud of this accomplishment as South Dakota does not have a statewide trauma system yet, but is in the planning stages for completion in 2012. MRH felt there was a very urgent need for this certification as the facility is in a remote area of South Dakota. MRH also provides various health screenings available to the community and surrounding communities throughout the year. The health screenings include free cholesterol checks, BMI, blood pressure and waist/hip ratios. These preventative health screenings promote the general health of the community.OtherInformation

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Compensation SurveyXCompensationSurvey
Board Or Committee ApprovalXBoardOrCommitteeApproval
Severance Payment0SeverancePayment
Supplemental Nonqual Retire Plan0SupplementalNonqualRetirePlan
Equity Based Comp Arrangement0EquityBasedCompArrangement
Comp Based On Revenue Of Filing Org0CompBasedOnRevenueOfFilingOrg
Comp Based On Revenue Related Orgs0CompBasedOnRevenueRelatedOrgs
Comp Based Net Earnings Filing Org0CompBasedNetEarningsFilingOrg
Comp Based Net Earnings Relate Orgs0CompBasedNetEarningsRelateOrgs
Any Non Fixed Payments0AnyNonFixedPayments
Initial Contract Exception0InitialContractException

Form990 Schedule J Part II Form990ScheduleJPartII (8 entries)

Base Compensation Filing OrgBaseCompensationFilingOrgComp Based On Related OrgsCompBasedOnRelatedOrgsBonus Filing OrgBonusFilingOrgBonus Related OrgsBonusRelatedOrgsOther Compensation Filing OrgOtherCompensationFilingOrgOther Compensation Related OrgsOtherCompensationRelatedOrgsDeferred Comp Filing OrgDeferredCompFilingOrgDeferred Comp Related OrgsDeferredCompRelatedOrgsNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgNontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgsTotal Compensation Filing OrgTotalCompensationFilingOrgTotal Compensation Related OrgsTotalCompensationRelatedOrgsComp Report Prior990 Filing OrgCompReportPrior990FilingOrgComp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs
Dr Travis Henderson
17960302112705403081290110950225357000
Dr Robert Marciano
1851750383440524808942075040245213000
Angelia Svihovec
132468000393055340114730149868000
Dr Bela Csaki
249735000855609989073860275666000
Dr Colette Ducheneaux
16066601460001842807131070780207903000
Dr Kenric Malmberg
16001401250001585306901074550202723000
Jim Curran
174264000311607229073070191916000
Debbie Smith
17891100075690570039270190977000

Form990 Schedule J Part III Form990ScheduleJPartIII

FieldValueIRS element (for citing)
IdentifierSupplemental InformationIdentifier
Return ReferencePart IIIReturnReference
ExplanationSchedule J, Part II: Angelia Svihovec's compensation The CEO is compensated for her services through a management agreement with St. Alexius Medical Center in Bismarck, ND.Explanation

Schedule K IRS990ScheduleK

Form990 Schedule K Part I Form990ScheduleKPartI

Issuer Name IssuerName

FieldValueIRS element (for citing)
Business Name Line1City of Mobridge South DakotaBusinessNameLine1
FieldValueIRS element (for citing)
Issuer EIN466000320IssuerEIN
CUSIP Number607429BA4CUSIPNumber
Date Issued2007-05-08DateIssued
Issue Price5773898IssuePrice
Description Of PurposeRefinanced existing tax-exempt bonds and purchase CT, Clinic and EMR.DescriptionOfPurpose
Defeased0Defeased
On Behalf Of Issuer0OnBehalfOfIssuer

Form990 Schedule K Part II Form990ScheduleKPartII

FieldValueIRS element (for citing)
Total Proceeds5773898TotalProceeds
Amount In Reserve Fund269394AmountInReserveFund
Amount Defeased4416499AmountDefeased
Issuance Costs From Proceeds88005IssuanceCostsFromProceeds
Capital Expenditures1000000CapitalExpenditures
Year Of Subst Completion2008YearOfSubstCompletion
Current Refunding0CurrentRefunding
Advance Refunding0AdvanceRefunding
Final Allocation Made1FinalAllocationMade
Adequate Books And Recds Maintaind1AdequateBooksAndRecdsMaintaind

Form990 Schedule K Part III Form990ScheduleKPartIII

FieldValueIRS element (for citing)
Owning Bond Financed Property0OwningBondFinancedProperty
Any Lease Arrangements0AnyLeaseArrangements
Mngment Cntrct Bond Financd Prprty0MngmentCntrctBondFinancdPrprty
Any Research Agreements0AnyResearchAgreements
Bond Counsel Routinely Engaged0BondCounselRoutinelyEngaged
Post Issuance Compliance Procdrs0PostIssuanceComplianceProcdrs

Form990 Schedule K Part IV Form990ScheduleKPartIV

FieldValueIRS element (for citing)
Form8038 T Filed0Form8038TFiled
Variable Rate Issue0VariableRateIssue
Hedge Identified In Books And Recds0HedgeIdentifiedInBooksAndRecds
Gross Proceeds Invested In GIC0GrossProceedsInvestedInGIC
Gross Proceeds Invested0GrossProceedsInvested
Exception To Rebate0ExceptionToRebate

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (8 entries)

IdentifierIdentifierExplanationExplanation
Form 990, Part VI, Section A, line 3MRH currently has a management agreement with St. Alexius Medical Center in Bismarck, ND. The agreement provides the CEO, Angelia K. Svihovec, and information technology support at a cost to MRH. The original management agreement date was January 1, 2000.
Form 990, Part VI, Section A, line 6There is only one class of member; all members have one vote (same voting rights).
Form 990, Part VI, Section A, line 7aThe nominating committee nominates candidates for election. The members vote on candidates at the annual meeting.
Form 990, Part VI, Section A, line 8bThere is no committee with the authority to act on behalf of the governing body.
Form 990, Part VI, Section B, line 11The CEO, CFO, and Finance Committee will review the Form 990 prior to filing with the IRS.
Form 990, Part VI, Section B, line 12cThe conflict of interest policy covers the entire Board of Directors. If a conflict should arise, it would first go to the CEO for evaluation, then to the Board of Directors for final evaluation. The Board of Directors is responsible for making the final decision in determining if a conflict exists. If a conflict is found, the person(s) involved would be required to abstain from discussions and voting on the item causing the conflict.
Form 990, Part VI, Section B, line 15The Finance Committee determines and approves the physician contracts, including compensation. The CEO's salary is determined using a salary survey and discussions with the management company. The Finance Committee approves the salary of the CEO annually. The Board of Directors approves the Finance Committee minutes, which include discussions regarding the CEO's salary. Salaries for other Officers or Key Employees are determined by the CEO through the use of salary survey information from SDAHO and employee service and experience files.
Form 990, Part VI, Section C, line 19Documents are made available upon request.

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