PHILIP HEALTH SERVICES INC: Form 990, tax year 2021
View the entire original 990 at ProPublica ↗
- Organization
- PHILIP HEALTH SERVICES INC (EIN 46-0361016)
- Tax period
- 2021-01-01 to 2021-12-31
- Filed
- 2022-11-10
- IRS object ID
- 202243149349302399
- Schema version
- 2021v4.0
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2022-11-10T10:20:37-05:00 | ReturnTs |
| Tax Period End | 2021-12-31 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 460393458 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | WOHLENBERG RITZMAN & CO LLC | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO BOX 1018 | AddressLine1Txt |
| City | YANKTON | CityNm |
| State Abbreviation | SD | StateAbbreviationCd |
| ZIP | 57078 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2021-01-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 460361016 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | PHILIP HEALTH SERVICES INC | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | PHIL | BusinessNameControlTxt |
| Phone | 6058592511 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 503 WEST PINE STREET | AddressLine1Txt |
| City | PHILIP | CityNm |
| State Abbreviation | SD | StateAbbreviationCd |
| ZIP | 57567 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | JEREMY SCHULTES | PersonNm |
| Person Title | CHIEF EXECUTIVE OFFI | PersonTitleTxt |
| Phone | 6058593908 | PhoneNum |
| Signature | 2022-10-15 | SignatureDt |
| Discuss With Paid Preparer | Yes (true) | DiscussWithPaidPreparerInd |
Signing Officer SigningOfficerGrp
Person Full Name PersonFullName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person First | JEREMY | PersonFirstNm |
| Person Last | SCHULTES | PersonLastNm |
| Field | Value | IRS element (for citing) |
|---|---|---|
| SSN | XXX-XX-XXXX | SSN |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | KATHLEEN DOYLE | PreparerPersonNm |
| PTIN | P01322431 | PTIN |
| Phone | 6056654401 | PhoneNum |
| Preparation | 2022-11-10 | PreparationDt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2021 | TaxYr |
| Build TS | 2022-09-23 18:48:47Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | JEREMY SCHULTES | PrincipalOfficerNm |
| Gross Receipts | $17,795,020 | GrossReceiptsAmt |
| Group Return For Affiliates | false | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | WWW.PHILIPHEALTHSERVICES.COM | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1953 | FormationYr |
| Legal Domicile State | SD | LegalDomicileStateCd |
| Activity Or Mission | TO PROVIDE HEALTH CARE TO PHILIP, SD & SURROUNDING AREAS | ActivityOrMissionDesc |
| Voting Members Governing Body | 7 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 7 | VotingMembersIndependentCnt |
| Total Employee | 205 | TotalEmployeeCnt |
| Total Volunteers | 19 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| PY Contributions Grants | $5,122,382 | PYContributionsGrantsAmt |
| CY Contributions Grants | $1,964,988 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $14,656,952 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $15,804,465 | CYProgramServiceRevenueAmt |
| PY Investment Income | $36,195 | PYInvestmentIncomeAmt |
| CY Investment Income | $25,567 | CYInvestmentIncomeAmt |
| CY Other Revenue | $0 | CYOtherRevenueAmt |
| PY Total Revenue | $19,815,529 | PYTotalRevenueAmt |
| CY Total Revenue | $17,795,020 | CYTotalRevenueAmt |
| CY Grants And Similar Paid | $0 | CYGrantsAndSimilarPaidAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $8,829,564 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $8,985,444 | CYSalariesCompEmpBnftPaidAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $12,223 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $5,531,850 | PYOtherExpensesAmt |
| CY Other Expenses | $5,917,430 | CYOtherExpensesAmt |
| PY Total Expenses | $14,361,414 | PYTotalExpensesAmt |
| CY Total Expenses | $14,902,874 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $5,454,115 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $2,892,146 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $18,448,221 | TotalAssetsBOYAmt |
| Total Assets EOY | $22,337,668 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $6,195,102 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $7,188,058 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $12,253,119 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $15,149,610 | NetAssetsOrFundBalancesEOYAmt |
| Mission | TO PROVIDE HEALTH CARE TO PHILIP, SD & SURROUNDING AREAS | MissionDesc |
| Significant New Program Srvc | false | SignificantNewProgramSrvcInd |
| Significant Change | false | SignificantChangeInd |
| Expense | $12,992,833 | ExpenseAmt |
| Revenue | $15,804,465 | RevenueAmt |
| Desc | THE FACILITY OPERATES A CRITICAL ACCESS HOSPITAL IN PHILIP, SD PROVIDING SHORT TERM INPATIENT, OUTPATIENT AND EMERGENCY HEALTH CARE SERVICES. THE FACILITY ALSO OPERATES AN ASSISTED LIVING FACILITY PROVIDING RESIDENTIAL CARE SERVICES, A SKILLED NURSING FACILITY PROVIDING LONG TERM NURSING HOME CARE, AND CLINIC FACILITIES FOR PHYSICIAN SERVICES. | Desc |
| Total Program Service Expenses | $12,992,833 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (true) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (true) | ScheduleBRequiredInd |
| Political Campaign Acty | false | PoliticalCampaignActyInd |
| Lobbying Activities | false | LobbyingActivitiesInd |
| Subject To Proxy Tax | false | SubjectToProxyTaxInd |
| Donor Advised Fund | false | DonorAdvisedFundInd |
| Conservation Easements | false | ConservationEasementsInd |
| Collections Of Art | false | CollectionsOfArtInd |
| Credit Counseling | false | CreditCounselingInd |
| Donor Rstr Or Quasi Endowments | false | DonorRstrOrQuasiEndowmentsInd |
| Report Land Building Equipment | Yes (true) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | false | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | false | ReportProgramRelatedInvstInd |
| Report Other Assets | Yes (true) | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (true) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | false | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | Yes (true) | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | false | ConsolidatedAuditFinclStmtInd |
| School Operating | false | SchoolOperatingInd |
| Foreign Office | false | ForeignOfficeInd |
| Foreign Activities | false | ForeignActivitiesInd |
| More Than5000 K To Org | false | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | false | MoreThan5000KToIndividualsInd |
| Professional Fundraising | false | ProfessionalFundraisingInd |
| Fundraising Activities | false | FundraisingActivitiesInd |
| Gaming Activities | false | GamingActivitiesInd |
| Operate Hospital | Yes (true) | OperateHospitalInd |
| Audited Financial Stmt Att | Yes (true) | AuditedFinancialStmtAttInd |
| Grants To Organizations | false | GrantsToOrganizationsInd |
| Grants To Individuals | false | GrantsToIndividualsInd |
| Schedule J Required | Yes (true) | ScheduleJRequiredInd |
| Tax Exempt Bonds | false | TaxExemptBondsInd |
| Engaged In Excess Benefit Trans | false | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | false | PYExcessBenefitTransInd |
| Loan Outstanding | false | LoanOutstandingInd |
| Grant To Related Person | false | GrantToRelatedPersonInd |
| Business Rln With Org Mem | false | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | false | BusinessRlnWithFamMemInd |
| Business Rln With35 Ctrl Ent | false | BusinessRlnWith35CtrlEntInd |
| Deductible Non Cash Contri | false | DeductibleNonCashContriInd |
| Deductible Art Contribution | false | DeductibleArtContributionInd |
| Terminate Operations | false | TerminateOperationsInd |
| Partial Liquidation | false | PartialLiquidationInd |
| Disregarded Entity | false | DisregardedEntityInd |
| Related Entity | Yes (true) | RelatedEntityInd |
| Related Organization Ctrl Ent | false | RelatedOrganizationCtrlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | false | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | false | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (true) | ScheduleORequiredInd |
| IRP Document | 22 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (true) | BackupWthldComplianceInd |
| Employee | 205 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (true) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | false | UnrelatedBusIncmOverLimitInd |
| Foreign Financial Account | false | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | false | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | false | TaxablePartyNotificationInd |
| Nondeductible Contributions | false | NondeductibleContributionsInd |
| Indoor Tanning Services | false | IndoorTanningServicesInd |
| Subj To Tax Rmnrtn Ex Prcht Pymt | false | SubjToTaxRmnrtnExPrchtPymtInd |
| Subject To Excs Tax Net Invst Inc | false | SubjectToExcsTaxNetInvstIncInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 7 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 7 | IndependentVotingMemberCnt |
| Family Or Business Rln | false | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | false | DelegationOfMgmtDutiesInd |
| Change To Org Documents | false | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | false | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | false | MembersOrStockholdersInd |
| Election Of Board Members | Yes (true) | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | Yes (true) | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (true) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (true) | MinutesOfCommitteesInd |
| Officer Mailing Address | false | OfficerMailingAddressInd |
| Local Chapters | false | LocalChaptersInd |
| Form990 Provided To Gvrn Body | false | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (true) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (true) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (true) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (true) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (true) | DocumentRetentionPolicyInd |
| Compensation Process CEO | Yes (true) | CompensationProcessCEOInd |
| Compensation Process Other | Yes (true) | CompensationProcessOtherInd |
| Investment In Joint Venture | false | InvestmentInJointVentureInd |
| Upon Request | Yes (X) | UponRequestInd |
| Other | Yes (X) | OtherInd |
Books In Care Of Detail BooksInCareOfDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | ORGANIZATION | PersonNm |
| Phone | 6058592511 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO BOX 790 | AddressLine1Txt |
| City | PHILIP | CityNm |
| State Abbreviation | SD | StateAbbreviationCd |
| ZIP | 57567 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (12 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Highest Compensated EmployeeHighestCompensatedEmployeeInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Key EmployeeKeyEmployeeInd | OfficerOfficerInd | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd |
|---|---|---|---|---|---|---|---|---|
| DAVID HOLMAN MD | ||||||||
| EMPLOYEE | 40.00 | Yes (X) | $337,853 | $0 | $22,395 | |||
| KERRY BLACKHAM | ||||||||
| EMPLOYEE | 40.00 | $317,916 | $0 | $19,336 | Yes (X) | |||
| COENRAAD KLOPPER MD | ||||||||
| EMPLOYEE | 40.00 | $231,569 | $0 | $25,882 | Yes (X) | |||
| JEREMY SCHULTES | ||||||||
| CHIEF EXECUT | 40.00 | $0 | $188,504 | $26,570 | Yes (X) | |||
| TERRY HENRIE | ||||||||
| EMPLOYEE | 40.00 | $182,893 | $0 | $5,487 | Yes (X) | |||
| DON BURNS | ||||||||
| PRESIDENT | 1.00 | $0 | $0 | $0 | Yes (X) | Yes (X) | ||
| LARRY GABRIEL | ||||||||
| VICE PRESIDE | 1.00 | $0 | $0 | $0 | Yes (X) | Yes (X) | ||
| KAREN KROETCH | ||||||||
| DIRECTOR | 1.00 | $0 | $0 | $0 | Yes (X) | |||
| RITA O'CONNELL | ||||||||
| DIRECTOR | 1.00 | $0 | $0 | $0 | Yes (X) | |||
| RUSTY OLNEY | ||||||||
| DIRECTOR | 1.00 | $0 | $0 | $0 | Yes (X) | |||
| DJ RUSH | ||||||||
| DIRECTOR | 1.00 | $0 | $0 | $0 | Yes (X) | |||
| RAY SMITH | ||||||||
| DIRECTOR | 1.00 | $0 | $0 | $0 | Yes (X) | |||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $1,070,231 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $188,504 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $99,670 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 17 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | false | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (true) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | false | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (5 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1Txt | CityContractorAddress/USAddress/CityNm | State AbbreviationContractorAddress/USAddress/StateAbbreviationCd | ZIPContractorAddress/USAddress/ZIPCd | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| RANGEL CONSTRUCTION | |||||
| 2626 W MAIN STREET | RAPID CITY | SD | 57702 | CONTRACTOR | $3,681,106 |
| ROVE STAFFING LLC | |||||
| PO BOX 31001 | PASADENA | CA | 91110 | NURSES | $352,016 |
| AVANT HEALTHCARE PROFESSIONALS | |||||
| PO BOX 744551 | ATLANTA | GA | 30374 | NURSES | $319,009 |
| MONUMENT HEALTH | |||||
| PO BOX 3450 | RAPID CITY | SD | 57709 | STAFFING/IT | $250,665 |
| CHAMBERLAIN ARCHITECTS | |||||
| 437 MAIN STREET | GRAND JUNCTION | CO | 81501 | ARCHITECTS | $208,463 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 5 | CntrctRcvdGreaterThan100KCnt |
| Government Grants | $1,849,287 | GovernmentGrantsAmt |
| All Other Contributions | $115,701 | AllOtherContributionsAmt |
| Total Contributions | $1,964,988 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (2 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| PATIENT SERVICE REVENUE | 621990 | $15,686,890 | $15,686,890 |
| OTHER OPERATING REVENUE | 621990 | $117,575 | $117,575 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $15,804,465 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $25,567 | TotalRevenueColumnAmt |
| Exclusion | $25,567 | ExclusionAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $17,795,020 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $15,804,465 | RelatedOrExemptFuncIncomeAmt |
| Exclusion | $25,567 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part IX | Yes (X) | InfoInScheduleOPartIXInd |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $188,904 | TotalAmt |
| Management And General | $188,904 | ManagementAndGeneralAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $7,340,090 | TotalAmt |
| Program Services | $6,940,519 | ProgramServicesAmt |
| Management And General | $399,571 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $158,581 | TotalAmt |
| Program Services | $142,723 | ProgramServicesAmt |
| Management And General | $15,858 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $779,920 | TotalAmt |
| Program Services | $720,996 | ProgramServicesAmt |
| Management And General | $58,924 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $517,949 | TotalAmt |
| Program Services | $494,032 | ProgramServicesAmt |
| Management And General | $23,917 | ManagementAndGeneralAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $25,702 | TotalAmt |
| Management And General | $25,702 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $42,716 | TotalAmt |
| Management And General | $42,716 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,989,081 | TotalAmt |
| Program Services | $1,525,070 | ProgramServicesAmt |
| Management And General | $451,788 | ManagementAndGeneralAmt |
| Fundraising | $12,223 | FundraisingAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $23,814 | TotalAmt |
| Program Services | $609 | ProgramServicesAmt |
| Management And General | $23,205 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $136,559 | TotalAmt |
| Program Services | $29,076 | ProgramServicesAmt |
| Management And General | $107,483 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,798,215 | TotalAmt |
| Program Services | $2,303,706 | ProgramServicesAmt |
| Management And General | $494,509 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $101,410 | TotalAmt |
| Program Services | $70,404 | ProgramServicesAmt |
| Management And General | $31,006 | ManagementAndGeneralAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $63,335 | TotalAmt |
| Program Services | $51,034 | ProgramServicesAmt |
| Management And General | $12,301 | ManagementAndGeneralAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $736,598 | TotalAmt |
| Program Services | $714,664 | ProgramServicesAmt |
| Management And General | $21,934 | ManagementAndGeneralAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $14,902,874 | TotalAmt |
| Program Services | $12,992,833 | ProgramServicesAmt |
| Management And General | $1,897,818 | ManagementAndGeneralAmt |
| Fundraising | $12,223 | FundraisingAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $9,020,110 | BOYAmt |
| EOY | $6,817,228 | EOYAmt |
Pledges And Grants Receivable PledgesAndGrantsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $302,593 | BOYAmt |
| EOY | $198,036 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,606,333 | BOYAmt |
| EOY | $2,751,986 | EOYAmt |
Oth Notes Loans Receivable Net OthNotesLoansReceivableNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $73,467 | BOYAmt |
| EOY | $64,919 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $250,342 | BOYAmt |
| EOY | $296,758 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $87,108 | BOYAmt |
| EOY | $37,860 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $17,749,559 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $7,623,693 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,922,293 | BOYAmt |
| EOY | $10,125,866 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $24,999 | BOYAmt |
| EOY | $31,322 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,160,976 | BOYAmt |
| EOY | $2,013,693 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $18,448,221 | BOYAmt |
| EOY | $22,337,668 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,689,665 | BOYAmt |
| EOY | $1,722,427 | EOYAmt |
Deferred Revenue DeferredRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,889,591 | BOYAmt |
| EOY | $436,677 | EOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,512,618 | BOYAmt |
| EOY | $4,953,676 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $103,228 | BOYAmt |
| EOY | $75,278 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $6,195,102 | BOYAmt |
| EOY | $7,188,058 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows FASB117 | Yes (X) | OrganizationFollowsFASB117Ind |
No Donor Restriction Net Assets NoDonorRestrictionNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $11,490,334 | BOYAmt |
| EOY | $14,853,411 | EOYAmt |
Donor Restriction Net Assets DonorRestrictionNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $762,785 | BOYAmt |
| EOY | $296,199 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $12,253,119 | BOYAmt |
| EOY | $15,149,610 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $18,448,221 | BOYAmt |
| EOY | $22,337,668 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | $2,892,146 | ReconcilationRevenueExpnssAmt |
| Net Unrlzd Gains Losses Invst | $4,345 | NetUnrlzdGainsLossesInvstAmt |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | false | AccountantCompileOrReviewInd |
| FS Audited | Yes (true) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Separate Basis Fincl Stmt | Yes (X) | SeparateBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | Yes (true) | AuditCommitteeInd |
| Federal Grant Audit Required | Yes (true) | FederalGrantAuditRequiredInd |
| Federal Grant Audit Performed | Yes (true) | FederalGrantAuditPerformedInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital | Yes (X) | HospitalInd |
Schedule B IRS990ScheduleB
Contributor Information ContributorInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor | RESTRICTED | ContributorNum |
Contributor Business Name ContributorBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor US Address ContributorUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Contributions | RESTRICTED | TotalContributionsAmt |
Schedule D IRS990ScheduleD
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $133,035 | OtherCostOrOtherBasisAmt |
| Book Value | $133,035 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $12,110,962 | OtherCostOrOtherBasisAmt |
| Depreciation | $5,028,665 | DepreciationAmt |
| Book Value | $7,082,297 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $3,921,014 | OtherCostOrOtherBasisAmt |
| Depreciation | $2,251,444 | DepreciationAmt |
| Book Value | $1,669,570 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $1,584,548 | OtherCostOrOtherBasisAmt |
| Depreciation | $343,584 | DepreciationAmt |
| Book Value | $1,240,964 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $10,125,866 | TotalBookValueLandBuildingsAmt |
Other Assets Org OtherAssetsOrgGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | CONSTRUCTION IN PROGRESS | Desc |
| Book Value | $2,013,693 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Other Assets | $2,013,693 | TotalBookValueOtherAssetsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | CAPITAL LEASE OBLIGATION | Desc |
| Amt | $75,278 | Amt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $75,278 | TotalLiabilityAmt |
| Total Rev Etc Audited Fincl Stmt | $17,799,365 | TotalRevEtcAuditedFinclStmtAmt |
| Net Unrealized Gains Invst | $4,345 | NetUnrealizedGainsInvstAmt |
| Revenue Not Reported | $4,345 | RevenueNotReportedAmt |
| Revenue Subtotal | $17,795,020 | RevenueSubtotalAmt |
| Total Revenue Per Form990 | $17,795,020 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $14,902,874 | TotExpnsEtcAuditedFinclStmtAmt |
| Expenses Subtotal | $14,902,874 | ExpensesSubtotalAmt |
| Total Expenses Per Form990 | $14,902,874 | TotalExpensesPerForm990Amt |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Assistance Policy | Yes (true) | FinancialAssistancePolicyInd |
| Written Policy | Yes (true) | WrittenPolicyInd |
| All Hospitals Policy | Yes (X) | AllHospitalsPolicyInd |
| FPG Reference Free Care | Yes (true) | FPGReferenceFreeCareInd |
| Percent100 | Yes (X) | Percent100Ind |
| FPG Reference Discounted Care | Yes (true) | FPGReferenceDiscountedCareInd |
| Percent200 D | Yes (X) | Percent200DInd |
| Free Care Medically Indigent | Yes (true) | FreeCareMedicallyIndigentInd |
| Financial Assistance Budget | Yes (true) | FinancialAssistanceBudgetInd |
| Expenses Exceed Budget | false | ExpensesExceedBudgetInd |
| Annual Community Bnft Report | false | AnnualCommunityBnftReportInd |
Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $116,804 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $116,804 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00780 | TotalExpensePct |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $1,159,996 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $1,607,610 | DirectOffsettingRevenueAmt |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $1,276,800 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $1,607,610 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $116,804 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00780 | TotalExpensePct |
Subsidized Health Services SubsidizedHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $1,115,740 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $539,749 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $575,991 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.03860 | TotalExpensePct |
Total Other Benefits TotalOtherBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $1,115,740 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $539,749 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $575,991 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.03860 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $2,392,540 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $2,147,359 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $692,795 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.04650 | TotalExpensePct |
Workforce Development WorkforceDevelopmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $23,177 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $23,177 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00160 | TotalExpensePct |
Total Communtity Building Acty TotalCommuntityBuildingActyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $23,177 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $23,177 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00160 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | Yes (true) | BadDebtExpenseReportedInd |
| Bad Debt Expense | $368,205 | BadDebtExpenseAmt |
| Reimbursed By Medicare | $7,395,174 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $7,267,563 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | $127,611 | MedicareSurplusOrShortfallAmt |
| Written Debt Collection Policy | Yes (true) | WrittenDebtCollectionPolicyInd |
| Financial Assistance Prvsn | Yes (true) | FinancialAssistancePrvsnInd |
| Hospital Facilities | 1 | HospitalFacilitiesCnt |
Hospital Facilities HospitalFacilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | HANS P PETERSON MEMORIAL HOSPITAL | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 503 W PINE ST | AddressLine1Txt |
| City | PHILIP | CityNm |
| State Abbreviation | SD | StateAbbreviationCd |
| ZIP | 57567 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Website Address | WWW.PHILIPHEALTHSERVICES.COM | WebsiteAddressTxt |
| State License | 10555 | StateLicenseNum |
| Licensed Hospital | Yes (X) | LicensedHospitalInd |
| Critical Access Hospital | Yes (X) | CriticalAccessHospitalInd |
| Emergency Room24 Hrs | Yes (X) | EmergencyRoom24HrsInd |
Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | HANS P PETERSON MEMORIAL HOSPITAL | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
| First Licensed CY Or PY | false | FirstLicensedCYOrPYInd |
| Tax Exempt Hospital CY Or PY | false | TaxExemptHospitalCYOrPYInd |
| CHNA Conducted | Yes (true) | CHNAConductedInd |
| Community Definition | Yes (X) | CommunityDefinitionInd |
| Community Demographics | Yes (X) | CommunityDemographicsInd |
| Existing Resources | Yes (X) | ExistingResourcesInd |
| How Data Obtained | Yes (X) | HowDataObtainedInd |
| Other Health Issues | Yes (X) | OtherHealthIssuesInd |
| Community Hlth Needs Id Process | Yes (X) | CommunityHlthNeedsIdProcessInd |
| Consulting Process | Yes (X) | ConsultingProcessInd |
| CHNA Conducted | 21 | CHNAConductedYr |
| Take Into Account Others Input | Yes (true) | TakeIntoAccountOthersInputInd |
| CHNA Conducted With Other Fclts | Yes (true) | CHNAConductedWithOtherFcltsInd |
| CHNA Conducted With Non Fclts | false | CHNAConductedWithNonFcltsInd |
| CHNA Report Widely Available | Yes (true) | CHNAReportWidelyAvailableInd |
| Rpt Available On Own Website | Yes (X) | RptAvailableOnOwnWebsiteInd |
| Own Website URL | WWW.PHILIPHEALTHSERVICES.COM | OwnWebsiteURLTxt |
| Implementation Strategy Adopt | false | ImplementationStrategyAdoptInd |
| Organization Incur Excise Tax | false | OrganizationIncurExciseTaxInd |
| Elig Criteria Explained | Yes (true) | EligCriteriaExplainedInd |
| FPG Family Incm Lmt Free Dscnt | Yes (X) | FPGFamilyIncmLmtFreeDscntInd |
| FPG Family Incm Lmt Free Care | 100.000000000000 | FPGFamilyIncmLmtFreeCarePct |
| FPG Family Incm Lmt Dscnt Care | 200.000000000000 | FPGFamilyIncmLmtDscntCarePct |
| Asset Level Criteria | Yes (X) | AssetLevelCriteriaInd |
| Explained Basis | Yes (true) | ExplainedBasisInd |
| App Financial Asst Expln | Yes (true) | AppFinancialAsstExplnInd |
| Described Info | Yes (X) | DescribedInfoInd |
| Described Suprt Doc | Yes (X) | DescribedSuprtDocInd |
| Provided Hospital Contact | Yes (X) | ProvidedHospitalContactInd |
| Provided Nonprofit Contact | Yes (X) | ProvidedNonprofitContactInd |
| Includes Publicity Measures | Yes (true) | IncludesPublicityMeasuresInd |
| FAP Available On Website | Yes (X) | FAPAvailableOnWebsiteInd |
| FAP Available On Website URL | WWW.PHILIPHEALTHSERVICES.COM | FAPAvailableOnWebsiteURLTxt |
| FAP Summary On Website | Yes (X) | FAPSummaryOnWebsiteInd |
| FAP Summary On Website URL | WWW.PHILIPHEALTHSERVICES.COM | FAPSummaryOnWebsiteURLTxt |
| FAP Avlbl On Request No Charge | Yes (X) | FAPAvlblOnRequestNoChargeInd |
| FAP App Avlbl On Request No Chrg | Yes (X) | FAPAppAvlblOnRequestNoChrgInd |
| FAP Sum Avlbl On Request No Chrg | Yes (X) | FAPSumAvlblOnRequestNoChrgInd |
| Communtity Notified FAP | Yes (X) | CommuntityNotifiedFAPInd |
| FAP Actions On Nonpayment | Yes (true) | FAPActionsOnNonpaymentInd |
| Permit No Actions | Yes (X) | PermitNoActionsInd |
| Collection Activities | false | CollectionActivitiesInd |
| Provided Written Notice | Yes (X) | ProvidedWrittenNoticeInd |
| Made Effort Orally Notify | Yes (X) | MadeEffortOrallyNotifyInd |
| Processed FAP Application | Yes (X) | ProcessedFAPApplicationInd |
| Made Presumptive Elig Determ | Yes (X) | MadePresumptiveEligDetermInd |
| Nondis Emergency Care Policy | Yes (true) | NondisEmergencyCarePolicyInd |
| Look Back Medicaid Medcr Prvt | Yes (X) | LookBackMedicaidMedcrPrvtInd |
| Amounts Generally Billed | false | AmountsGenerallyBilledInd |
| Gross Charges | false | GrossChargesInd |
Supplemental Information SupplementalInformationGrp (3 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FACILITY 1, HANS P PETERSON MEMORIAL HOSPITAL - PART V, LINE 5 | AS PART OF THE COMMUNITY HEALTH NEEDS ASSESSMENT, THERE WERE KEY INFORMANT FOCUS GROUPS HELD IN THE REGION - THESE FOCUS GROUPS ALLOWED FOR INPUT FROM PERSONS WITH SPECIAL KNOWLEDGE OF OR EXPERTISE IN PUBLIC HEALTH, AS WELL AS OTHERS WHO REPRESENT THE BROAD INTERESTS OF THE COMMUNITY SERVED BY THE HOSPITAL. PARTICIPANTS WERE CHOSEN BECAUSE OF THEIR ABILITY TO IDENTIFY PRIMARY CONCERNS OF THE POPULATIONS WITH WHOM THEY WORK AS WELL AS OF THE COMMUNITY OVERALL. PARTICIPANTS INCLUDED A REPRESENTATIVE OF PUBLIC HEALTH AS WELL AS SEVERAL INDIVIDUALS WHO WORK WITH LOW-INCOME, MINORITY OR OTHER MEDICALLY UNDERSERVED POPULATIONS AND THOSE WHO WORK WITH PERSONS WITH CHRONIC DISEASE CONDITIONS. TO OBTAIN ADDITIONAL INPUT FROM LOCAL RESIDENTS AND HEALTH CARE STAKEHOLDERS, THE HOSPITAL CONDUCTED AN ADDITIONAL SERIES OF FOCUS GROUPS IN 2021 WITH RESIDENTS FROM PHILIP, HAAKON COUNTY AND JACKSON COUNTY. |
| FACILITY 1, HANS P PETERSON MEMORIAL HOSPITAL - PART V, LINE 6A | THE COMMUNITY HEALTH NEEDS ASSESSMENT WAS SPONSORED BY A PARTNERSHIP BETWEEN HANS P PETERSON MEMORIAL HOSPITAL AND MONUMENT HEALTH |
| FACILITY 1, HANS P PETERSON MEMORIAL HOSPITAL - PART V, LINE 11 | AREAS OF OPPORTUNITY WERE PRIORITIZED AS FOLLOWS: 1.) MENTAL HEALTH; 2.) SUBSTANCE ABUSE; 3.) DIABETES; 4.) NUTRITION, PHYSICAL ACTIVITY & WEIGHT; 5.) TOBACCO USE; 6.) CANCER; 7.) INJURY & VIOLENCE PREVENTION; 8.) HEART DISEASE & STROKE; 9.) INFANT HEALTH & FAMILY PLANNING; 10.) ACCESS TO HEALTH CARE SERVICES; 11.) POTENTIALLY DISABLING CONDITIONS; 12.) SEXUAL HEALTH. IN ACKNOWLEDGING THE WIDE RANGE OF PRIORITY HEALTH ISSUES THAT EMERGED FROM THE CHNA PROCESS, THE HOSPITAL DETERMINED THAT IT COULD ONLY EFFECTIVELY FOCUS ON THOSE WHICH IT DEEMED MOST PRESSING, MOST UNDERADDRESSED, AND MOST WITHIN ITS ABILITY TO INFLUENCE. DUE TO LIMITED RESOURCES, SERVICES AND EXPERTISE AVAILABLE TO ADDRESS THESE HEALTH PRIORITIES, THE FOLLOWING WERE NOT CHOSEN FOR ACTION: SUBSTANCE ABUSE AND TOBACCO USE AND CANCER. REGARDING INJURY & VIOLENCE PREVENTION, THE HOSPITAL BELIEVES THAT THIS PRIORITY AREA FALLS MORE WITHIN THE PURVIEW OF THE COUNTY HEALTH DEPARTMENT AND OTHER COMMUNITY AND LAW ENFORCEMENT ORGANIZATIONS. LIMITED RESOURCES AND LOWER PRIORITY EXCLUDED THIS AS AN AREA FOR ACTION. |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 4 | FacilityNum |
Oth Hlth Care Fclts Not Hospital OthHlthCareFcltsNotHospitalGrp
Oth Hlth Care Fclts OthHlthCareFcltsGrp (4 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | FacilityFacilityTxt |
|---|---|---|---|---|
| PHILIP NURSING HOME | ||||
| 503 WEST PINE | PHILIP | SD | 57567 | NURSING HOME |
| SILVERLEAF ASSISTED LIVING FACILTIY | ||||
| 519 WEST PINE | PHILIP | SD | 57567 | ASSISTED LIVING FACILITY |
| PHILIP CLINIC | ||||
| 507 WEST PINE | PHILIP | SD | 57567 | RURAL HEALTH CLINIC |
| KADOKA CLINIC | ||||
| 601 CHESTNUT STREET | KADOKA | SD | 57543 | RURAL HEALTH CLINIC |
Supplemental Information Detail SupplementalInformationDetail (7 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| SCHEDULE H, PART I, LINE 3C | PATIENT COMPLETES AN APPLICATION WHICH GATHERS FINANCIAL INFORMATION RELATED TO THE PATIENT. NET WORTH IS CONSIDERED IN DETERMINING FREE OR DISCOUNTED CARE. DEBT OWED TO THE HOSPITAL MUST BE MORE THAN 20% OF THE PATIENT'S NET WORTH TO QUALIFY FOR FREE OR DISCOUNTED CARE. FAP ELIBIBLE INDIVIDUALS ARE NEVER CHARGED MORE THAN AGB. |
| SCHEDULE H, PART III, LINE 2 | THE FACILITY PROVIDES ALLOWANCES FOR DOUBTFUL RECEIVABLES EQUAL TO THE ESTIMATED COLLECTION LOSSES. THE ESTIMATED COLLECTION LOSSES ARE BASED ON HISTORICAL COLLECTION EXPERIENCE COUPLED WITH REVIEW OF THE CURRENT STATUS OF THE EXISTING RECEIVABLES. |
| SCHEDULE H, PART VI, LINE 2 | FACILITY MANAGEMENT, AS PART OF ITS OPERATIONAL PLANNING PROCESS, CONTINUALLY EVALUATES OPPORTUNITIES TO ADD NEW SERVICES TO THE CLINICAL SPECTRUM. SERVICES AVAILABLE IN THE REMOTE LOCATION ARE EVALUATED BASED ON THE CLINIAL CAPABILITIES OF THE AVAILABLE MEDICAL STAFF PROVIDERS AND SUPPORTIVE CLINICAL RESOURCES. THOSE FACTORS ARE BALANCED WITH THE NUMBER OF PEOPLE IN THE SERVICE AREA WHO DEMONSTRATE THE NEED FOR THOSE SERVICES. CLINICAL MODELS AND BUSINESS MODELS ARE MATCHED AND MONITORED OVER THE COURSE OF TIME TO DETERMINE THE FEASIBILITY OF NEW AND/OR EXISTING SERVICESS OFFERD IN THE COMMUNITY. |
| SCHEDULE H, PART VI, LINE 3 | SIGNS ARE POSTED AT ENTRANCES INFORMING THE PUBLIC OF THE COMMUNITY BENEFIT PROGRAM. |
| SCHEDULE H, PART VI, LINE 4 | THE ORGANIZATION SERVES THE SMALL TOWNS (POPULATIONS ARE LESS THAN 700) OF PHILIP, KADOKA, MIDLAND, WALL AND OTHERS, AS WELL AS THE RURAL RESIDENTS OF WESTERN SOUTH DAKOTA. THERE IS NO OTHER AVAILABLE HEALTH CARE WITHIN 90 MILES. |
| SCHEDULE H, PART VI, LINE 5 | PHILIP HEALTH SERVICES, INC, A NON-PROFIT COMMUNITY OWNED CORPORATION, HAS BEEN ABLE TO CONTINUE TO OFFER PRIMARY MEDICAL CARE TO THIS AREA IN LARGE PART DUE TO THE SUPPORT OF THE COMMUNITY AND THE LEARDERSHIP OF THE BOARD OF DIRECTORS. ALL NET GAINS ARE INVESTED BACK INTO THE ORGANIZATION TO MAINTAIN CURRENT SERVICES AND EXPAND SERVICES. |
| SCHEDULE H, PART VI | PART III, SEC B, LINE 8 - COMMUNITY BENEFIT THE MEDICARE SHORT FALL IS ALL CONSIDERED COMMUNITY BENEFIT. THERE IS NO ADDITIONAL FUNDING SOURCE TO OFFSET THE MEDICARE SHORTFALL. SERVICES ARE PROVIDED TO MEDICARE BENEFICIARIES IN ALL AREAS OF THE HOSPITAL KNOWING THAT MEDICARE COSTS WILL NOT BE FULLY RECOVERED. |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Severance Payment | false | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | false | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | false | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | false | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | false | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | false | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | false | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | false | AnyNonFixedPaymentsInd |
| Initial Contract Exception | false | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (5 entries)
| TitleTitleTxt | Base Compensation Filing OrgBaseCompensationFilingOrgAmt | Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt | Total Compensation Filing OrgTotalCompensationFilingOrgAmt | Compensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmt | Deferred Comp Rltd OrgsDeferredCompRltdOrgsAmt | Total Compensation Rltd OrgsTotalCompensationRltdOrgsAmt |
|---|---|---|---|---|---|---|
| DAVID HOLMAN MD | ||||||
| EMPLOYEE | $337,853 | $22,395 | $360,248 | |||
| KERRY BLACKHAM | ||||||
| EMPLOYEE | $317,916 | $19,336 | $337,252 | |||
| COENRAAD KLOPPER MD | ||||||
| EMPLOYEE | $231,569 | $25,882 | $257,451 | |||
| JEREMY SCHULTES | ||||||
| CHIEF EXECUTIVE OFFI | $188,504 | $26,570 | $215,074 | |||
| TERRY HENRIE | ||||||
| EMPLOYEE | $182,893 | $5,487 | $188,380 | |||
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (10 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PAGE 1, PART I, LINE 6 | BOARD MEMBERS SERVE WITHOUT COMPENSATION VOLUNTEERS ENTERTAIN NURSING RESIDENTS |
| FORM 990, PAGE 6, PART VI, LINE 7A | MEMBERS ELECT THE GOVERNING BOARD AT THE ANNUAL MEETING |
| FORM 990, PAGE 6, PART VI, LINE 7B | BOARD DECISIONS ARE NOT SUBJECT TO APPROVAL OF MEMBERS |
| FORM 990, PAGE 6, PART VI, LINE 11B | CHIEF EXECUTIVE REVIEWS 990 WHICH IS PREPARED BY AN AUDITING FIRM |
| FORM 990, PAGE 6, PART VI, LINE 12C | OFFICERS, DIRECTORS AND KEY EMPLOYEES REQUIRED TO ANNUALLY DISCLOSE INTERESTS THAT COULD GIVE RISE TO CONFLICTS |
| FORM 990, PAGE 6, PART VI, LINE 15A | ANNUAL BOARD EVALUATION CONDUCTED WITH INPUT FROM REGIONAL HEALTH PERSONNEL |
| FORM 990, PAGE 6, PART VI, LINE 15B | PHYSICIANS HAVE EMPLOYMENT CONTRACTS |
| FORM 990, PAGE 6, PART VI, LINE 18 | GUIDESTAR.COM |
| FORM 990, PAGE 6, PART VI, LINE 19 | GOVERNING DOCUMENTS ARE MADE AVAILABLE ON REQUEST |
| FORM 990, PART IX, LINE 11G | EDUCATION/TRAINING 23,624 1,336 0 CONSULTANTS 141,109 425,636 0 PHYSICIAN FEES 17,639 0 0 MAINTENANCE CONTRACT 57,398 20,367 0 RECRUITMENT 18,728 4,449 0 PROFESSIONAL FEES-OTHER 1,101,080 0 12,223 REFERENCE LAB 165,492 0 0 TOTAL 1,525,070 451,788 12,223 |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp
Disregarded Entity Name DisregardedEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | MONUMENT HEALTH | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO BOX 6000 | AddressLine1Txt |
| City | RAPID CITY | CityNm |
| State Abbreviation | SD | StateAbbreviationCd |
| ZIP | 57709 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Primary Activities | REIMBURSEM | PrimaryActivitiesTxt |
| Legal Domicile State | SD | LegalDomicileStateCd |
| Exempt Code Section | 501 | ExemptCodeSectionTxt |
| Public Charity Status | 3 | PublicCharityStatusTxt |
| Direct Controlling NA | N/A | DirectControllingNACd |
| Controlled Organization | false | ControlledOrganizationInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | false | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | false | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | false | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | false | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | false | LoansOrGuaranteesFromOthOrgInd |
| Div Related Organization | false | DivRelatedOrganizationInd |
| Asset Sale To Other Org | false | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | false | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | false | AssetExchangeInd |
| Rental Of Facilities To Oth Org | false | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | false | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | false | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | false | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | false | SharingOfFacilitiesInd |
| Paid Employees Sharing | false | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | Yes (true) | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | false | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | false | TransferToOtherOrgInd |
| Transfer From Other Org | false | TransferFromOtherOrgInd |
Transactions Related Org TransactionsRelatedOrgGrp
Other Organization Name OtherOrganizationName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | MONUMENT HEALTH | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Transaction Type | P | TransactionTypeTxt |
| Involved | $1,583,124 | InvolvedAmt |
| Method Of Amount Determination | CASH EXPENDITURES | MethodOfAmountDeterminationTxt |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | SCHEDULE R | FormAndLineReferenceDesc |
| Explanation | ON OCTOBER 1, 2011, THE FACILITY ENTERED INTO A MANAGEMENT AGREEMENT WITH MONUMENT HEALTH (MH) TO PROVIDE SERVICES TO THE HOSPITAL, CLINICS AND ASSISTED LIVING FACILITY. MH PROVIDES THE FOLLOWING SERVICES; ADMINISTRATOR, SUPPORTING SERVICES, OTHER SPECIFIC SERVICES, ATTENDANCE AT MEETINGS, REPORTS AND EDUCATION. IN CONSIDERATION FOR THESE SERVICES, THE FACILITY REIMBURSES MH 100% OF THE ADMINISTRATORS BASE SALARY AND BENEFITS, REIMBURSES MH 2,582 PER MONTH FOR OTHER SPECIFIC SERVICES AND REIMBURSES MH THE ACTUAL COST OF SUPPORTING SERVICES. THE AGREEMENT TERMINATED ON SEPTEMBER 30,2021. THE FACILITY ENTERED INTO A NEW MANAGEMENT AGREEMENT WITH MONUMENT HEALTH (MH) FOR THE SAME SERVICES AS THE PRIOR AGREEMENT ON OCTOBER 1, 2021. THE NEW AGREEMENT EXPIRES SEPTEMBER 30, 2031. EITHER PARTY MAY TERMINATE THE AGREEMENT SOONER, WITH OR WITHOUT CAUSE, BY GIVING 90 DAYS WRITTEN NOTICE OF TERMINATION. | ExplanationTxt |