2023-04-18T11:17:12-05:00 2022-05-31 410746749 CLIFTONLARSONALLEN LLP 220 S 6TH STREET SUITE 300 MINNEAPOLIS MN 55402 990 2021-06-01 460391067 PRAIRIE LAKES HEALTH CARE SYSTEM INC PRAI 6058827000 PO BOX 1210 WATERTOWN SD 57201 JAY HODGES INTERIM CFO 6058827000 2023-04-18 1 JAY HODGES 999009999 ROBERT E SCHILE P00369682 6123764500 2023-04-18 3 AAL1 IAL1 2021 2023-04-26 12:10:37Z JOHN ALLEN PO BOX 1210 WATERTOWN SD 57201 177474778 0 X WWW.PRAIRIELAKES.COM X 1986 SD PROVIDE HIGH QUALITY, AFFORDABLE & COMPASSIONATE HEALTHCARE SERVICES FOR THE PEOPLE IN THE REGION. 14 12 705 84 1244102 381322 3449979 3089804 114864228 115911149 19358709 19570123 1547575 1872492 139220491 140443568 182680 4265261 0 0 55269622 59475377 0 0 0 55456213 61849878 110908515 125590516 28311976 14853052 435632850 432088879 53291480 52046490 382341370 380042389 WE MAKE A POSITIVE DIFFERENCE IN THE HEALTH OF THE PATIENTS AND COMMUNITIES WE SERVE. 0 0 107383940 4265261 140443568 PRAIRIE LAKES HEALTH CARE SYSTEM SERVES TEN COUNTIES IN NORTHEASTERN SOUTH DAKOTA AND WESTERN MINNESOTA AS A RURAL, REGIONAL MEDICAL CENTER. IT IS COMMITTED TO PROVIDING ACCESSIBLE, HIGH QUALITY, COST-EFFECTIVE HEALTHCARE SERVICES AS IT MANAGES EFFECTIVELY THE TRANSITION TO NEW PAYMENT AND CARE DELIVERY MODELS. 28 SPECIALTY PHYSICIANS HAVE BEEN RECRUITED OVER THE PAST DECADE TO BUILD NEW SERVICES AND BETTER SERVE THE NEEDS OF THE REGION. 107383940 1 1 0 1 0 0 0 0 0 0 1 0 0 1 1 1 0 1 0 0 1 0 0 0 0 0 1 1 1 0 1 1 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 1 98 0 1 705 1 1 1 0 0 0 0 0 0 0 0 0 0 0 X 14 12 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 0 0 X JAY HODGES 6058827000 401 9TH AVENUE NW WATERTOWN SD 57201 ROBB PETERSON CHAIR 1.00 0.00 X X 0 0 0 SHANNON KRUSE VICE CHAIR 1.00 0.00 X X 0 0 0 VINCE FOLEY SECRETARY 1.00 0.00 X X 0 0 0 MIKE LUKEN TREASURER 1.00 0.00 X X 0 0 0 JIM REDLINGER PAST CHAIR 1.00 0.00 X 0 0 0 MARK ROBY BOARD MEMBER 1.00 0.00 X 0 0 0 CHRIS CARTER BOARD MEMBER 1.00 0.00 X 0 0 0 ALAN CHRISTENSEN MD BOARD MEMBER 1.00 0.00 X 0 0 0 KRISTIN HENDERSON BOARD MEMBER 1.00 0.00 X 0 0 0 SCOTT MUNGER BOARD MEMBER 1.00 0.00 X 0 0 0 TAMMY DAVIS BOARD MEMBER 1.00 0.00 X 0 0 0 GERALD RIEBER MD BOARD MEMBER 1.00 0.00 X 0 0 0 JONATHAN OVIATT BOARD MEMBER 1.00 0.00 X 0 0 0 D ADAM POPP CFO 40.00 0.00 X 283692 0 25982 PAUL MACEK INTERIM PRESIDENT/CEO 40.00 0.00 X 210189 0 0 DR LEIGHTON SINGH CHIEF OF STAFF EX OFFICIO/ DIRECTOR 1.00 0.00 X 596130 0 32808 MICHELE TURBAK CNO 40.00 0.00 X 265187 0 25551 NATE LAKE VICE PRESIDENT (THROUGH FEB 2022) 40.00 0.00 X 253337 0 33529 TRACI RABINE VICE PRESIDENT 40.00 0.00 X 253445 0 31800 GRANT TILLETT CHIEF INFORMATION OFFICER (THROUGH MAR 2022) 40.00 0.00 X 240186 0 31203 EVELIO GARCIA MD PHYSICIAN 40.00 0.00 X 1323608 0 32808 SALEM MAALIKI MD PHYSICIAN 40.00 0.00 X 1417308 0 26589 JEFFREY SMITH MD PHYSICIAN 40.00 0.00 X 1299913 0 32808 VIJAY RAO MD PHYSICIAN 40.00 0.00 X 804329 0 24108 GREG GERRISH MD PHYSICIAN 40.00 0.00 X 763736 0 32808 KC DEBOER FORMER CEO (THROUGH SEPT 2021) 40.00 0.00 X 531152 0 36270 8242212 0 366264 77 1 1 0 GHAITH ABOUD MD 920 3RD ST NW APT C WATERTOWN SD 57201 LOCUM PHYSICIAN 724440 WEATHERBY LOCUMS PO BOX 972633 DALLAS TX 75397 LOCUM COVERAGE 538002 MEDICAL SOLUTIONS PO BOX 310737 DES MOINES IA 50331 LOCUM COVERAGE 400892 WAPITI MEDICAL GROUP 107 FLYNN DRIVE STE 600 MILBANK SD 57252 LOCUM COVERAGE 310692 DMS HEALTH TECHNOLOGIES PO BOX 670747 DALLAS TX 75267 PET SCAN 249330 21 3083234 6570 3089804 NET PATIENT SERVICE REVENUE 621400 114766128 114766128 RETAIL PHARMACY 446110 874712 874712 LAB SERVICE 621500 270309 270309 115911149 5081037 99081 4981956 1172176 0 1172176 1172176 1172176 51519792 504 37031210 0 14488582 504 14489086 14489086 OTHER INCOME 624100 458873 458873 CAFETERIA REVENUE 624210 240062 240062 VENDING MACHINES 722515 1338 1338 43 43 700316 140443568 114766128 1244102 21343534 4265261 4265261 1720596 1720596 796544 701471 95073 48366730 44086627 4280103 1141789 1044922 96867 4213320 3810848 402472 3236398 2849101 387297 172143 172143 184359 184359 1578358 1578358 12505297 9436993 3068304 580402 580402 1441778 893881 547897 1028061 200888 827173 998659 25977 972682 498367 498367 256812 193393 63419 828616 828616 6884475 4519835 2364640 414749 414749 DRUGS 13439280 13439280 MEDICAL SUPPLIES 12880064 12880064 PROVISION FOR BAD DEBT 4565776 4565776 EQUIP RENT/MAINTENANCE 2153243 2151746 1497 1439439 576145 863294 125590516 107383940 18206576 0 2086 2186 21791241 10718503 11540954 11136013 346220 555577 3290632 4100386 1320167 1354351 167335670 94696151 76304047 72639519 291213271 301225629 5700030 5392483 3409614 3274649 20714588 21689583 435632850 432088879 14916467 16062301 2905618 3707082 27665874 25528941 7803521 6748166 53291480 52046490 X 376951526 374705797 5389844 5336592 382341370 380042389 435632850 432088879 X 14853052 -20598568 3446535 X X 0 1 X 1 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 1 10601 0 0 0 10601 0 PART II-B, LINE 1: THE LOBBYING EXPEDITURES ARE THE PORTION OF DUES TO VARIOUS HOSPITAL ASSOCATIONS THAT ARE USED FOR LOBBYING. 4207780 4207780 85865645 35545732 50319913 2932961 2353298 579663 72782519 56797121 15985398 1546765 1546765 72639519 DUE FROM 457(B) PLAN 5749565 ACCRUED REAL ESTATE 15940018 21689583 457(B) PAYABLE 5749565 LONG-TERM PTO 906701 ASSET RETIREMENT OBLIGATION 91900 6748166 X PART X, LINE 2: THE INTERNAL REVENUE SERVICE (IRS) HAS DETERMINED THAT PRAIRIE LAKES IS A TAX-EXEMPT, NOT-FOR-PROFIT CORPORATION UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE (IRC). THE HEALTH SYSTEM FOLLOWS THE GUIDANCE IN THE ACCOUNTING STANDARDS REGARDING THE RECOGNITION AND MEASUREMENT OF UNCERTAIN TAX POSITIONS. THE GUIDANCE CLARIFIES THE ACCOUNTING FOR UNCERTAINTY IN INCOME TAXES RECOGNIZED IN AN ENTITY'S FINANCIAL STATEMENTS. THE GUIDANCE FURTHER PRESCRIBES RECOGNITION AND MEASUREMENT OF TAX PROVISIONS TAKEN OR EXPECTED TO BE TAKEN ON A TAX RETURN THAT ARE NOT CERTAIN TO BE REALIZED. THE APPLICATION OF THIS STANDARD HAS NO IMPACT ON THE HEALTH SYSTEM'S FINANCIAL STATEMENTS. CENTRAL AMERICA AND THE CARIBBEAN 0 0 INVESTMENTS 15940018 0 0 0 0 0 0 15940018 0 15940018 1 0 0 1 1 0 PART III ACCOUNTING METHOD: 1 1 X 1 X 1 X 1 1 1 0 1 1 3539315 3539315 0.02920 11304670 3069638 8235032 0.06800 14843985 3069638 11774347 0.09720 7888 7888 0.00010 17869016 9806975 8062041 0.06660 17876904 9806975 8069929 0.06670 32720889 12876613 19844276 0.16390 7888 7888 0.00010 7888 7888 0.00010 1 4565776 38471737 35773368 2698369 X 1 1 1 1 PRAIRIE LAKES HOSPITAL 401 9TH AVE NW WATERTOWN SD 57201 WWW.PRAIRIELAKES.COM 10572 460391067 X X X PRAIRIE LAKES HEALTH CARE SYSTEM 1 0 0 1 X X X X X X X X X 21 1 0 0 1 X SEE PART V.C. X 1 21 1 SEE PART V, SECTION C 0 1 X 150.000000000000 200.000000000000 X X X X 1 1 X X X X 1 X SEE LINE 16J X SEE LINE 16J X SEE LINE 16J X X X X X X X 1 X 0 X X 1 X 0 0 PRAIRIE LAKES HEALTH CARE SYSTEM PART V, SECTION B, LINE 5: PLHS UTILIZED COUNTY HEALTH RANKINGS TO SEE HEALTH OUTCOMES AND HEALTH FACTORS FOR BOTH THE PRIMARY AND SECONDARY SERVICE AREA. THE COUNTY HEALTH RANKINGS SHOWED DIFFERENCES BETWEEN THE COUNTY'S VALUES AND STATE OR NATIONAL AVERAGE. THESE AREAS TO EXPLORE WERE COMPARED WITH DATA FROM THE COMMUNITY. IN ORDER TO ADDRESS THE NEEDS OF THE ENTIRE "COMMUNITY," STAKEHOLDERS INCLUDED INDIVIDUALS FROM OUTSIDE THE PRIMARY SERVICE AREA OF PLHS. INPUT WAS OBTAINED THROUGH TWO FOCUS GROUP SESSIONS. SESSIONS WERE HELD OVER 2 DAYS AND APPROXIMATELY 25 ORGANIZATIONS WERE REPRESENTED. IN ADDITION TO FOCUS GROUPS THE HUMAN SERVICE AGENCY IN COLLABORATION WITH A GRADUATE STUDENT PROJECT PERFORMED A COMMUNITY SURVEY FOR RESEARCH AND ANALYSIS IN SPRING OF 2021. THE CODINGTON COUNTY WELFARE COMMISSIONER'S ASSET MAP WAS VIEWED TO ESTABLISH SYSTEMS OF CARE TO IMPROVE COMMUNITY SERVICES. THE DATA FROM FOCUS GROUPS, THE COMMUNITY SURVEY, AND ASSET MAP WERE COMPLIED. ANY AREAS THAT OVERLAPPED BETWEEN THE COUNTY HEATH RANKINGS AND THE FOCUS GROUPS WAS REVIEWED BY THE CHNA WORK GROUP AND PRIORITIZED THE NEEDS IDENTIFIED. PRAIRIE LAKES HEALTH CARE SYSTEM PART V, SECTION B, LINE 7D: THE ORGANIZATION'S COMMUNITY HEALTH NEEDS ASSESSMENT REPORT AND IMPLEMENTATION STRATEGY ARE AVAILABLE ONLINE AT HTTPS://WWW.PRAIRIELAKES.COM/COMMUNITY/COMMUNITY-BENEFIT-513.HTML. PRAIRIE LAKES HEALTH CARE SYSTEM PART V, SECTION B, LINE 11: 1. MENTAL AND BEHAVIORAL HEALTH-PLHS PROVIDES STAFF MEMBERS WITH RESOURCES THAT CAN BE UTILIZED SUCH AS ASSISTANCE PROGRAMS FOR MENTAL HEALTH SERVICES AND A RESPITE LOUNGE-PLHS COLLABORATES WITH THE FOLLOWING ORGANIZATIONS WATERTOWN BOYS AND GIRLS CLUB TO SUPPORT THEIR EFFORTS, H.S.A TO SUPPORT THEIR SUICIDE PREVENTION SERVICES AND ANNUAL AWARENESS WALK. SERENITY HILLS- A FACILITY AND SAFE HOUSE FOR THOSE SUFFERING FROM MENTAL ILLNESS COMMUNITY TRANSIT WATERTOWN/SISSETON-TRANSPORT INDIVIDUALS TO MENTAL HEALTH APPOINTMENTS.2. HEALTH EDUCATION, LITERACY, AND PREVENTION-VIDEOS AND EDUCATION ARE DISPLAYED ON THE WEBSITE FOR EASE OF ACCESS TO EDUCATE THE PUBLIC. IN ADDITION, MONTHLY PRIORITY HEALTH ARTICLES ARE IN THE LOCAL PAPER, POSTED TO THE WEBSITE AND SHARED ON SOCIAL MEDIA. PLHS ALSO DOES EDUCATION RADIO INTERVIEWS ON LOCAL STATIONS AND OFFERS LARGE IN PERSON AND ONLINE EVENTS.HEALTH SCREENINGS ARE BEING PROMOTED TO ASSIST WITH PREVENTION.3. SMOKING/DRUGS/ALHOHOL-VIDEOS AND EDUCATION ARE DISPLAYED ON THE WEBSITE WHICH FOCUS ON DISEASES CAUSED BY USING THE SUBSTANCES. A FULL-TIME MIDLEVEL WAS ADDED TO WORK ALONGSIDE A FULL-TIME PULMONOLOGIST TO EASE ACCESS BARRIERS. PLHS WORKING TO START A SERVICE LINE FOR PAIN THERAPY. AS WELL AS OFFER FREE COMMUNITY PAIN EDUCATION CLASSES.-PLHS COLLABORATES WITH THE FOLLOWING ORGANIZATIONS BY PROVIDING FINANCIAL SUPPORTSERENITY HILLSDASHWATERTOWN HEALTHY YOUTHWATERTOWN AREA UNITED WAYBOYS AND GIRLS CLUB OF WATERTOWNSIGNIFICANT NEEDS TO ASSESSEDMANY ISSUES EMERGED THAT WERE BEYOND THE SCOPE OR CONTROL OF PLHS. ISSUES SUCH AS AFFORDABILITY OF CARE/UNDERINSURED, ECONOMY & WORKFORCE SHORTAGE, UNEMPLOYMENT, SEX EDUCATION/TEEN PREGNANCY, AND PRIMARY CARE PHYSICIANS WILL BE DEFERRED TO THE APPROPRIATE COMMUNITY ORGANIZATIONS. PRAIRIE LAKES HEALTH CARE SYSTEM PART V, SECTION B, LINE 16J: HTTPS://WWW.PRAIRIELAKES.COM/BILLING-AND-INSURANCE/FINANCIAL-ASSISTANCE-PROGRAM-510.HTML 3 1 - SISSETON SATELLITE DIALYSIS 5 EAST CHESTNUT SISSETON SD 57262 DIALYSIS UNIT 2 - MALLARD POINTE SURGICAL CENTER 1425 MICKELSON DRIVE WATERTOWN SD 57201 OUTPATIENT SURGERY CENTER 3 - ORTONVILLE SATELLITE DIALYSIS 450 EASTVOLD AVENUE ORTONVILLE MN 56278 DIALYSIS UNIT PART I, LINE 3C: IN ADDITION TO INCOME BASED CRITERIA FOR DETERMINING THE AMOUNT OF FINANCIAL ASSISTANCE SERVICES FOR WHICH A PATIENT IS ELIGIBLE AT THE TIME OF SERVICE OR DURING THE BILLING-AND-COLLECTION PROCESS, PLHS USES AN ASSET TEST. ASSET EXCLUSIONS THAT ARE CONSIDERED IN QUALIFYING FOR FINANCIAL ASSISTANCE ARE: (A) EQUITY IN PRIMARY RESIDENCE UP TO $15,000(B) EQUITY IN AUTOMOBILE UP TO $5,000(C) 70% OF VALUE OF ASSETS IN RETIRMENT ACCOUNTS(D) ASSETS IN CHECKING/SAVINGS/ETC. UP TO $15,000(E) OTHER ASSETS USED FOR INCOME PRODUCING PURPOSES. PART I, LINE 7: THE COSTS OF THE SUBSIDIZED SERVICES ARE BASED ON DIRECT COST PROVIDED BY THE DEPARTMENTS FOR THE SERVICES. PART I, LINE 7G: THE SUBSIDIZED HEALTH SERVICES INCLUDED IN SCHEDULE H, PART I, LINE 7G RELATE TO THE EMERGENCY ROOM, CARDIOLOGY CLINIC, ONCOLOGY CLINIC, NEPHROLOGY CLINIC, UROLOGY CLINIC, PULMONOLOGY CLINIC, AND ENT CLINIC. PART I, LN 7 COL(F): $4,565,776 OF BAD DEBT EXPENSE WAS ELIMINATED WHEN CALCULATING PART I, LINE 7, COLUMN F. PART II, COMMUNITY BUILDING ACTIVITIES: THE ORGANIZATION SUPPORTS COMMUNITY BUILDING ACTIVITIES THROUGH DONATIONS TO COMMUNITY PROJECTS SUCH AS THE WATERTOWN COMMUNITY FOUNDATION WHICH WORKS TO BRING NEW BUSINESSES TO WATERTOWN, JOY RANCH WHICH PROVIDES CAMP EXPERIENCE TO DISABLED CHILDREN, LAKE AREA TECHNICAL COLLEGE WHICH PROVIDES EDUCATION AND TRAINING FOR HEALTH PROFESSIONALS, THE BOYS AND GIRLS CLUB WHICH PROVIDES RESOURCES FOR COMMUNITY YOUTH. PART III, LINE 2: IN EVALUATING THE COLLECTABILITY OF PATIENT ACCOUNTS RECEIVABLE, THE HEALTH SYSTEM ANALYZES ITS PAST HISTORY AND IDENTIFIES TRENDS FOR EACH OF ITS MAJOR PAYER SOURCES OF REVENUE TO ESTIMATE THE APPROPRIATE ALLOWANCE FOR DOUBTFUL ACCOUNTS AND PROVISION FOR BAD DEBTS. MANAGEMENT REGULARLY REVIEWS DATA ABOUT THESE MAJOR PAYER SOURCES OF REVENUE IN EVALUATING THE SUFFICIENCY OF THE ALLOWANCE FOR DOUBTFUL ACCOUNTS. FOR RECEIVABLES ASSOCIATED WITH SERVICES PROVIDED TO PATIENTS WHO HAVE THIRD-PARTY COVERAGE, THE HEALTH SYSTEM ANALYZES CONTRACTUALLY DUE AMOUNTS AND PROVIDES AN ALLOWANCE FOR DOUBTFUL ACCOUNTS AND A PROVISION FOR BAD DEBTS, IF NECESSARY. FOR RECEIVABLES ASSOCIATED WITH SELF-PAY PATIENTS (WHICH INCLUDES BOTH PATIENTS WITHOUT INSURANCE AND PATIENTS WITH DEDUCTIBLE AND COPAYMENT BALANCES DUE FOR WHICH THIRD-PARTY COVERAGE EXISTS FOR PART OF THE BILL), THE HEALTH SYSTEM RECORDS A SIGNIFICANT PROVISION FOR BAD DEBTS IN THE PERIOD OF SERVICE ON THE BASIS OF ITS PAST EXPERIENCE, WHICH INDICATES THAT MANY PATIENTS ARE UNABLE OR UNWILLING TO PAY THE PORTION OF THEIR BILL FOR WHICH THEY ARE FINANCIALLY RESPONSIBLE. PART III, LINE 3: THE ORGANIZATION DOES NOT HAVE A WAY TO IDENTIFY THE NUMBER OF PEOPLE WHO WOULD QUALIFY FOR FINANCIAL ASSISTANCE SO WE HAVE REPORTED $0 IN PART III, LINE 3. PART III, LINE 4: SEE THE "PATIENT ACCOUNTS RECEIVABLE" PARAGRAPH ON PAGE 9 OF THE AUDITED FINANCIAL STATEMENTS. PART III, LINE 8: THERE WAS NO SHORTFALL CALCULATED IN PART III, LINE 7.THE MEDICARE ALLOWABLE COSTS INCLUDED IN PART III, LINE 6 WAS DERIVED USING THE 2022 FILED MEDICARE COST REPORT. PART III, LINE 9B: BILLING STATEMENTS AND COLLECTION LETTERS WILL CONTAIN INFORMATION DIRECTING PATIENTS TO CONTACT THE HOSPITAL FOR INFORMATION ABOUT FINANCIAL ASSISTANCE OR PAYMENT PLANS IF THE PATIENTS ARE UNABLE TO PAY THE FULL OUTSTANDING ACCOUNT BALANCE BY THE DUE DATE. IF A COMPLETE ASSISTANCE APPLICATION IS RECEIVED, A DETERMINATION OF THE PATIENT'S ELIGIBILITY WILL BE DOCUMENTED APPROPRIATELY AND COMMUNICATED TO THE PATIENT IN WRITING. IF ELIGIBLE, THE HOSPITAL WILL ISSUE A BILLING STATEMENT WITH THE AMOUNT NOW OWED (ALONG WITH THE AMOUNT GENERALLY BILLED AND HOW IT WAS CALCULATED), REFUND ANY CREDIT BALANCES, AND REVERSE ANY EXTRAORDINARY COLLECTION ACTIONS. IF AN INCOMPLETE FINANCIAL ASSISTANCE APPLICATION (FAA) IS RECEIVED BY THE HOSPITAL, THE HOSPITAL WILL CEASE COLLECTION ACTIONS AND ALLOW 30 DAYS FOR THE FAA TO BE FULLY COMPLETED. PART VI, LINE 2: THE FACILITY CONDUCTS NEEDS ASSESSMENT SURVEYS IN THE COMMUNITY AND SURROUNDING AREA TO DETERMINE WHAT HEALTH CARE SERVICES NEED TO BE ADDRESSED. PART VI, LINE 3: PLHS INFORMS AND EDUCATES PATIENTS ABOUT FINANCIAL ASSISTANCE THROUGH INFORMATION PROVIDED ON THE PLHS WEBSITE. FURTHERMORE, HOSPITAL STAFF PROVIDE INFORMATION REGARDING FINANCIAL ASSISTANCE ELIGIBILITY. PART VI, LINE 4: PRAIRIE LAKES HEALTH CARE SYSTEM'S PRIMARY SERVICE AREA COVERS 3 COUNTIES IN SOUTH DAKOTA WITH A POPULATION OF APPROXIMATELY 38,000. IT'S SECONDARY SERVICE AREA COVERS 4 COUNTIES IN SOUTH DAKOTA AND 3 COUNTIES IN MINNESOTA WITH A POPULATION OF 49,000. PART VI, LINE 5: THE ORGANIZATION OFFERS HEALTH SEMINARS FREE TO COMMUNITY MEMBERS COVERING A VARIETY OF HEALTH TOPICS IN AN EFFORT TO EDUCATE PEOPLE ABOUT LEADING HEALTHY LIVES. COMMUNITY FORUMS ARE HELD TO UPDATE ATTENDEES ABOUT NEW EVENTS AND TECHNOLOGY AT THE FACILITY. THE ORGANIZATION WORKS WITH THE TECHNICAL COLLEGE AND TWO STATE UNIVERSITIES TO HELP TRAIN MEDICAL STUDENTS. THE ORGANIZATION IS DEDICATED TO IMPLEMENTING AND MAINTAINING THE MOST CURRENT TECHNOLOGY IN PROVIDING CARE. PART VI, LINE 7, REPORTS FILED WITH STATES SD 1 WATERTOWN AREA UNITED WAY PO BOX 283 WATERTOWN SD 57201 460359557 501(C)(3) 35000 0 SUPPORT OF NEW BUSINESS DEVELOPMENT LAKE AREA TECHNICAL INSTITUTE FOUNDATION PO BOX 730 WATERTOWN SD 57201 363860861 501(C)(3) 18130 0 SCHOLARSHIPS HUMAN SERVICE AGENCY PO BOX 1030 WATERTOWN SD 57201 460275247 501(C)(3) 30000 0 DETOX UNIT SUPPORT WATERTOWN DEVELOPMENT CORP PO BOX 1267 WATERTOWN SD 57201 466012194 501(C)(6) 80000 0 SUPPORT NEW BUSINESS DEVELOPMENT JOY RANCH 16633 448TH AVENUE FLORENCE SD 57235 871202375 501(C)(3) 4000000 0 SUPPORT FOR FAMILY PLANNING CENTER BOYS & GIRLS CLUB OF WATERTOWN PO BOX 833 WATERTOWN SD 57201 460311845 501(C)(3) 6000 0 SUPPORT CASTLEWOOD COMMUNITY FOUNDATION PO BOX 263 CASTLEWOOD SD 57223 822466393 501(C)(3) 25000 0 SUPPORT CODINGTON COUNTY HISTORICAL SOCIETY 27 1ST AVENUE SOUTHEAST WATERTOWN SD 57201 460335602 501(C)(3) 10000 0 SUPPORT SOUTHEAST TECHNICAL COLLEGE 201 EAST 38TH STREET SIOUX FALLS SD 57105 466002586 501(C)(3) 24000 0 SUPPORT PART I, LINE 2: FUNDS ARE GRANTED BASED ON ORGANIZATIONS AND INTERNAL REQUESTS. GRANT REQUESTS ARE REVIEWED AND APPROVED BY ADMINISTRATIVE LEADERSHIP TO BE USED FOR THE PURPOSES REQUESTED BY THE ORGANIZATION. FURTHER MONITORING IS NOT DONE ON A REGULAR BASIS. X X X X 1 1 0 0 0 0 0 0 0 SALEM MAALIKI MD PHYSICIAN 1416108 0 1200 0 0 0 8700 0 17889 0 1443897 0 0 0 EVELIO GARCIA MD PHYSICIAN 1222408 0 101200 0 0 0 8700 0 24108 0 1356416 0 0 0 JEFFREY SMITH MD PHYSICIAN 902016 0 397897 0 0 0 8700 0 24108 0 1332721 0 0 0 VIJAY RAO MD PHYSICIAN 628879 0 175450 0 0 0 0 0 24108 0 828437 0 0 0 GREG GERRISH MD PHYSICIAN 572135 0 191601 0 0 0 8700 0 24108 0 796544 0 0 0 DR LEIGHTON SINGH CHIEF OF STAFF EX OFFICIO/ DIRECTOR 594930 0 1200 0 0 0 8700 0 24108 0 628938 0 0 0 KC DEBOER FORMER CEO (THROUGH SEPT 2021) 449952 0 81200 0 0 0 12162 0 24108 0 567422 0 0 0 D ADAM POPP CFO 220432 0 63260 0 0 0 8386 0 17596 0 309674 0 0 0 MICHELE TURBAK CNO 205159 0 60028 0 0 0 7955 0 17596 0 290738 0 0 0 NATE LAKE VICE PRESIDENT (THROUGH FEB 2022) 194858 0 58479 0 0 0 9421 0 24108 0 286866 0 0 0 TRACI RABINE VICE PRESIDENT 194586 0 58859 0 0 0 7692 0 24108 0 285245 0 0 0 GRANT TILLETT CHIEF INFORMATION OFFICER (THROUGH M 186361 0 53825 0 0 0 7095 0 24108 0 271389 0 0 0 PAUL MACEK INTERIM PRESIDENT/CEO 210189 0 0 0 0 0 0 0 0 0 210189 0 0 0 PART I, LINES 4A-B K.C. DEBOER, FORMER CEO, RECEIVED SEVERANCE PAYMENTS OF $531,152 IN REGULAR COMPENSATION AND $36,270 IN NON-TAXABLE COMPENSATION IN THE 2021 TAX YEAR. A SOUTH DAKOTA HEALTH AND EDUCATIONAL FACILITIES AUTHORITY 460315509 2017-01-27 36000000 FUNDING OF THE NEW SPECIALTY CLINIC BUILDING 0 0 0 A 10345000 36000000 397999 35602001 2017 0 0 1 1 A 0 1 0 0 0 0 1 A 0 1 0 0 0 0 0 0 1 A 1 GREGORY GERRISH MD CATHERINE GERRISH IS A FORMER BOARD MEMBER AND THE MOTHER OF GREGORY GERRIS 763736 EMPLOYEE COMPENSATION 0 FORM 990, PART VI, SECTION A, LINE 1A THE EXECUTIVE COMMITTEE SHALL BE COMPRISED OF THE OFFICERS OF THE CORPORATION. EXCEPT AS MAY BE LIMITED BY THE BOARD, THE EXECUTIVE COMMITTEE SHALL HAVE AND EXERCISE THE AUTHORITY OF THE BOARD IN THE MANAGEMENT OF THE BUSINESS OF THE CORPORATION. THE EXECUTIVE COMMITTEE SHALL ACT IN THE INTERVALS BETWEEN MEETINGS OF THE BOARD AND SHALL AT ALL TIMES BE SUBJECT TO THE CONTROL AND DIRECTION OF THE BOARD. THE EXECUTIVE COMMITTEE SHALL ALSO SERVE AS THE CORPORATION'S COMPENSATION COMMITTEE, UNLESS IT OR THE BOARD DELEGATES THOSE RESPONSIBILITIES TO ANOTHER COMMITTEE OF THE BOARD. THE EXECUTIVE COMMITTEE SHALL NOT USURP THE FUNCTIONS OF THE OTHER STANDING COMMITTEES, ALTHOUGH IT WILL COORDINATE PROJECTS, TASKS AND COMMUNICATIONS AMONG SUCH COMMITTEES. A MAJORITY OF THE EXECUTIVE COMMITTEE SHALL CONSTITUTE A QUORUM FOR THE TRANSACTION OF ANY BUSINESS. FORM 990, PART VI, SECTION B, LINE 11B EXECUTIVE MANAGEMENT REVIEWS THE FORM 990 IN DETAIL. THE FORM 990 IS PRESENTED TO THE FINANCE COMMITTEE CHAIR FOR FINAL REVIEW PRIOR TO FILING WITH THE IRS. FORM 990, PART VI, SECTION B, LINE 12C A CONFLICT OF INTEREST STATEMENT IS SIGNED BY ALL BOARD MEMBERS ANNUALLY. THIS STATEMENT DISCLOSES ANY AREAS THAT MAY POTENTIALLY PRESENT A CONFLICT OF INTEREST WITH THEMSELVES OR FAMILY MEMBERS. THE CONFLICT OF INTEREST POLICY IS MONITORED BY THE CEO AND THE BOARD. MEMBERS WILL EXCUSE THEMSELVES DURING BOARD MEETING FROM ANY DISCUSSION OR VOTING ON AN ISSUE WHERE THERE MAY BE A CONFLICT OF INTEREST. FORM 990, PART VI, SECTION B, LINE 15A COMPENSATION COMPARABILITY STUDIES ARE REVIEWED EACH YEAR FOR ALL POSITIONS BY THE HUMAN RESOURCES DEPARTMENT. THE HUMAN RESOURCES DEPARTMENT HAS ACCESS TO VARIOUS COMPENSATION SURVEYS, WHICH ARE REVIEWED TO DETERMINE IF THE HOSPITAL'S COMPENSATION IS REASONABLE COMPARED TO OTHER FACILITIES. THE BOARD DELEGATES VICE PRESIDENT EXECUTIVE COMPENSATION APPROVAL TO THE CEO BASED ON THE ORGANIZATION'S COMPENSATION PHILOSOPHY IN CONJUCTION WITH MARKET BENCHMARKS. THE EXECUTIVE COMMITTEE REVIEWS AND APPROVES THE SALARIES OF OTHER KEY EMPLOYEES. THIS PROCESS WAS LAST COMPLETED IN 2021. FORM 990, PART VI, SECTION C, LINE 19 FINANCIAL STATEMENTS ARE AVAILABLE THROUGH FILINGS WITH BONDING AUTHORITY. GOVERNING DOCUMENTS AND THE CONFLICT OF INTEREST POLICY ARE NOT MADE AVAILABLE TO THE PUBLIC. FORM 990, PART XI, LINE 9: CHANGE IN BENEFICIAL INTEREST IN PRAIRIE LAKES FOUNDATION -53,252. CHANGE IN HCI NET ASSETS 3,499,787. FORM 990, PART XII, LINE 2C: THIS PROCESS HAS NOT CHANGED FROM PRIOR YEAR.