2018-08-15T10:10:26-05:00 2017-09-30 450250958 EIDE BAILLY LLP 4310 17TH AVE S PO BOX 2545 FARGO ND 581082545 990 2016-10-01 411763968 Prairie Ridge Hospital and Health Services Inc PRAI 2186857300 1411 Highway 79 E Elbow Lake MN 56531 Kyle Richards Lake Region Healthcare CEO 2186857300 2018-08-15 1 LISA CHAFFEE CPA P00193453 7012398500 2018-08-15 2016 2022-09-23 18:48:47Z Danielle Lesmeister 1411 Highway 79 E Elbow Lake MN 56531 20120736 0 X www.prairiehealth.org X 1993 MN An acute care hospital and ambulatory outpatient facility. 5 4 172 0 0 0 128886 70859 17165270 19923913 34570 125164 1343 800 17330069 20120736 0 0 0 0 5794990 5673438 0 0 0 12297272 13430307 18092262 19103745 -762193 1016991 31451284 32953193 24321710 24726240 7129574 8226953 Serving the healthcare needs of the people. 0 0 15537405 19923913 Prairie Ridge Hospital and Health Services (Medical Center) maintains and operates a hospital and an ambulatory outpatient facility for the care and treatment of the sick, diseased, disabled, aged or indigent persons and participates in various activities to promote the general health of the community. The Medical Center operates various provider based clinics and a provider based surgery department. The Medical Center maintains records to identify and monitor the level of charity care it provides. These records include the amount of charges foregone for services and supplies furnished under its charity care policy. The amount of charges foregone, based on established rates were $38,757 and $53,354 during the years ended September 30, 2017 and September 30, 2016. 15537405 1 1 0 0 0 0 0 0 0 1 1 0 0 0 1 1 0 1 0 0 0 0 0 0 0 0 1 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 0 1 36 0 1 172 1 0 0 0 0 0 0 0 0 0 0 X 5 4 1 0 0 0 1 1 1 1 0 0 0 1 1 1 1 1 1 0 0 0 MN X Krista Gerber 2186857337 1411 Highway 79 E Elbow Lake MN 56531 X Gene Wenstrom Chair 2.50 4.20 X X 600 0 0 David Bjork Vice Chair (Oct-Feb) 1.50 5.00 X X 1200 0 0 Sandy Alvstad Secretary(Oct-Jul) 1.50 0.00 X X 1200 0 0 Jay McNamar VC & Sec (Apr-Sept)/Dir (Oct-Apr) 1.50 0.00 X X 1200 0 0 Dustin Sperr Director/Co-CMO 2.40 0.00 X 9874 0 0 Gary Spies Director 1.50 5.00 X 1200 0 0 Richard Lambert Director (Jun-Sept) 1.50 0.00 X 0 0 0 Danielle Lesmeister Director (Jun-Aug) 1.50 0.00 X 0 0 0 Jim Gingerich Interim CEO (Oct-Jul) 40.00 0.00 X 0 10986 0 Kyle Richards Interim CEO (Aug-Sept) 0.00 40.00 X 0 0 0 Brett Longtin CFO (Oct-Sept)/CEO (Oct-Nov) 0.00 40.00 X 0 259665 17303 Barbara Moore Physical Therapist 40.00 0.00 X 108517 0 11636 Renae Lien Pharmacy Director 40.00 0.00 X 125840 0 4253 249631 270651 33192 2 0 1 0 Lake Region Healthcare Co 712 S Cascade St Fergus Falls MN 56538 Professional/Physician Services 2971406 West Central Internal Medicine PO Box 410 Morris MN 56267 Physician Services 421232 CPSI 6600 Wall Street Mobile AL 36695 IT Support 269712 DMS Imaging Inc PO Box 670747 Dallas TX 75267 Radiology Services 252524 Morris Electronics Inc 511 Atlantic Ave Morris MN 56267 IT Services 225524 9 8536 62323 70859 Net Patient Service Rev. 622110 18032171 18032171 Pharmacy 722320 1673703 1673703 Supporting Revenue 900099 212350 212350 Rural Alliance Investment 900099 5689 5689 19923913 76756 76756 800 0 800 800 800 40408 8000 0 0 40408 8000 48408 48408 20120736 19923913 0 125964 X 6900 6900 4838113 3337309 1500804 101980 70345 31635 371503 256261 115242 354942 244837 110105 60000 60000 78921 78921 5196873 4149438 1047435 23054 23054 582300 471752 110548 379239 40409 338830 35415 28114 7301 45012 30425 14587 828802 828802 1963371 1963371 98356 98356 Medical Supplies 3002195 3002195 Repairs and Maintenance 436086 390467 45619 Bad Debt Expense 345618 345618 MN Health Tax 238085 238085 116980 41621 75359 19103745 15537405 3566340 0 1901977 5357923 4295865 3975659 290536 253221 225525 195295 28771405 8549406 22037890 20221999 2402252 2698465 81094 69676 216145 180955 31451284 32953193 1412097 1698345 22532713 22042095 376900 985800 24321710 24726240 X 6845750 7925327 54276 72078 229548 229548 7129574 8226953 31451284 32953193 1016991 80388 0 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 283824 17802 301626 270034 13790 283824 315032 -4998 40000 270034 309625 5407 315032 284404 25221 309625 0.00000 0.76100 0.23900 0 0 570277 570277 21445141 4025241 17419900 6747987 4524165 2223822 8000 8000 20221999 Due to Third Party Payor 985800 985800 X 19855506 80388 -345618 -265230 20120736 0 20120736 18758127 0 18758127 345618 345618 19103745 Part V, Line 4: Endowment funds are intended to earn investment income. The investment income is intended to be used for funding operational expenses. Part X, Line 2: PRHHS is organized as a Minnesota nonprofit corporation and has been recognized by the Internal Revenue Service (IRS) as exempt from federal income taxes under Internal Revenue Code Section 501(c)(3). PRHHS is annually required to file a Return of Organization Exempt from Income Tax (Form 990) with the IRS. In addition, PRHHS is subject to income tax on net income that is derived from business activities that are unrelated to their exempt purpose. PRHHS has determined they are not subject to unrelated business income tax and has not filed an Exempt Organization Business Income Tax Return (Form 990T) with the IRS. PRHHS believes that it has appropriate support for any tax positions taken affecting its annual filing requirements, and as such, does not have any uncertain tax positions that are material to the consolidated financial statements. PRHHS would recognize future accrued interest and penalties related to unrecognized tax benefits and liabilities in income tax expense if such interest and penalties are incurred. Part XI, Line 2d - Other Adjustments: Bad Debt Expense Included in Expenses in Financial Statements -345,618. Part XII, Line 4b - Other Adjustments: Bad Debt Expense Included in Revenue in Financial Statements 345,618. 1 1 X 1 X 175.000000000000 1 X 215.000000000000 1 0 1 1 29000 29000 0.00150 2613339 2378716 234623 0.01250 2642339 2378716 263623 0.01400 225875 70223 155652 0.00830 5772835 4316918 1455917 0.07760 5998710 4387141 1611569 0.08590 8641049 6765857 1875192 0.09990 0 345618 42856 7562984 7604145 -41161 X 1 1 1 1 Prairie Ridge Hospital & Health Services 1411 Highway 79 E Elbow Lake MN 56531 www.prairiehealth.org 00154 X X X X 5 provider based clinics Prairie Ridge Hospital and Health Servic 1 0 0 1 X X X X X X X X X 15 1 0 0 1 X See Part V, Section B, Line 7d X 1 15 1 See Part V, Section B, Line 7d 0 1 X 175.000000000000 215.000000000000 X X X 1 1 X X X X 1 X www.prairiehealth.org/patients-visitors/financial-assistance/ X www.prairiehealth.org/patients-visitors/financial-assistance/ X www.prairiehealth.org/patients-visitors/financial-assistance/ X X X X X X 1 X 0 X X X 1 X 0 0 Prairie Ridge Hospital and Health Service Part V, Section B, Line 5: We put together a committee of community members comprised of:A Prairie Ridge board member, area director of public health, a licensed social worker with an area nursing home, a branch manager with a home healthcare agency, the facilitator with a child and youth council, the counselor for the area school district, a former teacher, the county social services director, and the dean of students for the local school district.We met several times in order to identify what needs our area has. We also conducted a public survey via handout and the internet in order to get outside feedback. Prairie Ridge Hospital and Health Service Part V, Section B, Line 7d: Line 7 Hospital Website:https://www.prairiehealth.org/about-us/community-health-needs-assessment/ Prairie Ridge Hospital and Health Service Part V, Section B, Line 11: The Hospital is addressing the needs listed below which were identified in the 2015 tax year CHNA. The initiatives that were taken by year end are addressed below.1) Preventative CareCurrent activities * Prairie Ridge has a practitioner with an interest in diabetes. * We hold a free monthly diabetic education support group that covers a variety of topics for those who have diabetes and their loved ones. * Through the diabetic education program we offer a free membership to the Prairie Ridge Fitness Center to qualifying members. * Prairie Ridge works with Lake Region Healthcare dieticians on addressing dietary issues in the community and with our patients. * Prairie Ridge has put into place additional screening for well child exams in order to identify potential issues early on. * Prairie Ridge operates a 24/7 fitness center that is open to the community. * We work with a wide variety of insurance programs in order to allow access to as many members of the community as we can. * Prairie Ridge contracts with 4 area school districts to provide school nursing. * Prairie Ridge has 6 locations in order to provide better access to care. A sixth location in Herman, MN was opened in March 2017. * Prairie Ridge has added a second evening clinic to allow better access to healthcare. 2) Aging PopulationCurrent activities * Prairie Ridge hired a nurse specifically to work with our aging population. * The services provided by the nurse include annual wellness visit reminders. * Chronic Care Management provides a care coordinator for patients with multiple diagnoses. * This nurse visits with area senior groups to educate them on services available to them. * Prairie Ridge has partnered with the PAD PRAIRIE initiative and has received training to perform screenings on patients to better diagnose PAD. * Implemented Transitional Care Management which helps manage the care after discharge. * Prairie Ridge offers swing bed services.Conducted by others in collaboration with Prairie Ridge: * Prairie Ridge has partnered with the PAD PRAIRIE initiative. * Prairie Ridge promoted community awareness of PAD through community events * Prairie Ridge facilitated screening and identification of PAD * Nursing homes in Barrett and Evansville provide assisted living, but Prairie Ridge physicians provide care to the residents and lab services.3) Mental and Behavioral Health ServicesCurrent activities * The school district has providers who come in to meet with students. * Prairie Ridge has a contract with Bridgeway Behavioral Health at Lake Region Healthcare. * Prairie Ridge works with the Region 4 Mental Health Crisis team. * Prairie Ridge conducts continued education with staff in dealing with mental health and behavior health patients. * Prairie Ridge is working with LRH to implement and provide mental health services locally via telemedicine at PRHHS. The proposed implementation date is in FY 2018. Proposed activities * Prairie Ridge is working on policies and procedures to turn one of our hospital rooms into a safe room for mental health and behavior health patients. This will help us to create a safe environment for our patients dealing with mental and/or behavioral health issues. * Prairie Ridge will continue to contract with Bridgeway Behavioral Health to provide services for patients with mental/behavioral health issues * Prairie Ridge will continue to ensure practitioners are aware of the signs of mental health issues and encourage them to refer to specialists. This will help practitioners to better serve and treat our patients. * Prairie Ridge will continue to educate patients about the services available to them. This will allow us to better serve our patients by connecting them with the correct services to best address their needs.4) Dental Care for Low Income Families and Transportation are two needs that were identified but will not be addressed specifically by Prairie Ridge due to funding. The community has organizations that serves the community with these needs. Prairie Ridge provides information to its patients on the resources available in these areas. Prairie Ridge Hospital and Health Service Part V, Section B, Line 16j: The Hospital provided a summary of the financial assistance policy with the patient billing invoices, posted a summary in the emergency rooms and waiting rooms, as well as the admissions office and their website. The full policy was available upon request. 1 1 - Herman Clinic 204 5th St E Herman MN 56248 Physician Clinic Part I, Line 6a: The annual community benefit report is available to the public upon request and on the PRHHS website. Part I, Line 7: Charity care was converted to cost by multiplying the ratio of cost to charges for the Hospital by the gross uncompensated charges associated with providing charity care to its patients. Medicaid is reported at cost according to the amounts on the Medicaid Cost Report. Community health improvement services and donations are reported based on actual expenses recorded to the general ledger. Subsidized health services are reported according to costs allocated to the relevant cost centers on the Medicare Cost Report. Part I, Ln 7 Col(f): The amount of bad debt expense removed from the denominator of the calculation was $345,618. Part III, Line 2: Bad debt expense on line 2 is reported at charges as presented on the financial statements. A payment on an account previously written off reduces bad debt expense in the current year. Part III, Line 3: The estimated amount of bad debt expense attributable to patients eligible under the organization's charity care policy is calculated by using the ratio of the population in the service area that is below the FPG of 12.4% to the total population and multiplying that percentage times the bad debt expense at cost. Part III, Line 4: The footnote to the Organization's financial statements can be found on page 9 of the attached audited financial statements. Part III, Line 8: Medicare allowable costs of care are based on the Medicare cost report. The Medicare cost report is completed based on the rules and regulations set forth by Centers for Medicare and Medicaid Services.Even though Medicare was at a loss, the Hospital provides services to these patients because access to healthcare and individual's health is important to the Hospital. Therefore, the Medicare shortfall is considered a community benefit. Part III, Line 9b: For patients unable to meet the collection guidelines of Prairie Ridge Hospital and Health Services, notice of the Charity Care Program and appropriate forms (including the financial disclosure statement) will be supplied to the patient for completion and consideration in satisfying the balance remaining due. Once the patient begins the application process, the Hospital ceases all collection action on the amounts being considered for financial assistance. If there is a payment made on the account during the application process, the payment is applied directly to the account balance. Individuals are given 240 days to complete the FAP application. Part VI, Line 2: In addition to the CHNA process that took part in tax year 2015, the organization assesses the health care needs of the community based on feedback from physicians. Part VI, Line 3: Information regarding charity care is available in admission areas and in clinic patient rooms. If a patient is past due on a bill, an additional notification is given to the patient to contact the hospital to discuss payment options, including charity care. The hospital provides counseling to patients to help them qualify for Medicaid. Part VI, Line 4: Prairie Ridge Hospital and Health Services service area includes Grant County and surrounding counties in Minnesota. In 2015, the population for Grant County was estimated to be 5,903. In 2014, approximately 23.3% of the population is age 65 or older. The average per capita income is $27,195 and approximately in 2013 12.4% of the population is below the federal poverty level. The nearest hospital in the area is approximately 20 miles from Prairie Ridge Hospital and Health Services main campus. Part VI, Line 5: The Organization's governing body is comprised of volunteer members who reside in the community. Medical staff privileges are extended to all qualified physicians in the community. Surplus funds are reinvested in facilities to improve patient care. The hospital operates an emergency room that is available to all, regardless of ability to pay.Prairie Ridge Hospital and Health Services (PRHHS) is the sole healthcare provider within the Elbow Lake Community. The satellite clinics located in Ashby, Evansville, Hoffman and Herman provide clinic and lab services. The Morris satellite clinic provides outpatient surgery, clinic, lab and radiology services to the Morris area.PRHHS supports the education and training of various healthcare professionals. Nurse Practitioner, Physician Assistant, Radiology, Physical Therapy and nursing professionals-in-training shadow PRHHS providers during their various internships.In keeping with the hospital's mission of "Serving the healthcare needs of the people" PRHHS provides:Support Groups - PRHHS provides free use of the facility for support groups on a monthly basis. Groups include: Grief Support and Diabetic SupportTransportation - To facilitate transportation for patients in Morris to the Prairie Ridge Morris facility, PRHHS pays a monthly stipend to a public transit that allows those patients to attend their appointments without paying transportation costs.Ambulance - PRHHS Ambulance and Emergency Staff are present in case of emergency at local school activities such as football, wrestling, etc. In addition they are present at county fairs and other local events.Blood Pressure Checks - Free blood pressure checks are available at all times in both the clinic and hospital setting at all PRHHS sites. These checks are at no cost to the patient whether or not they are an established patient.Expos - PRHHS participates in the Grant County and Stevens County Fairs where we provide various information.Sports Physicals - School sports physicals are performed at a reduced rate for the schools in our area.Spry - Spry is a publication sponsored by PRHHS that provides various health related information on various topics including a variety of conditions as well as information on maintaining good health.Community Pages - Listed through the community pages are the various support groups and any health related activities provided at various times for various occasions (i.e. Community Safety, Drug Education, etc.). Part VI, Line 7, Reports Filed With States MN 0 0 0 0 0 0 0 0 0 Brett Longtin CFO (Oct-Sept)/CEO (Oct-Nov) 0 232915 0 26750 0 0 0 0 0 17303 0 276968 0 0 Part I, Line 3 The CEO for PRHHS is a LRHC employee, therefore they establish the CEO's compensation pursuant to compensation studies performed by an independent party using market data. LRHC used all methods listed on line 3. Form 990, Part VI, Section A, line 2 Jim Gingerich, Dr. Dustin Sperr, Brett Longtin, Gary Spies, Dr. David Bjorke and Gene Wenstrom all have a business relationship. Form 990, Part VI, Section A, line 6 Lake Region Healthcare Corporation ("Lake Region"), a Minnesota nonprofit corporation, is the sole corporate member of the Corporation. Form 990, Part VI, Section A, line 7a Lake Region has reserved exclusively to itself the power to appoint board members from a slate of candidates nominated by the Corporation's Board. Form 990, Part VI, Section A, line 7b Lake Region has reserved exclusively to itself the following reserved powers: a. Approval of Operating and Capital Budget recommended by the Corporation's Board; b. Approval of Strategic Plan recommended by the Corporation's Board; c. Approval of any recommendation by the Corporation's Board to substantially change its purpose or mission or to transfer assets; d. Amendment of Articles of Incorporation, Bylaws, and other Corporate Documents; e. Approval of Contracts involving Physicians or other Providers, for compliance purposes only; f. Board member appointment, for a slate of candidates nominated by the Corporation's Board; g. Approval of incurrence of debt in excess of thresholds established by Lake Region policy; h. Approval of joint ventures or partnerships proposed to be entered into by the Corporation; and i. Approval of the creation by the Corporation of any new corporation, limited liability company, or other entity. Form 990, Part VI, Section A, line 8b Currently the organization does not have any committees with the authority to act on behalf of the governing body. Form 990, Part VI, Section B, line 11b The return is to be reviewed by both LRHC and PRHHS CEOs, then followed by a review by the PRHHS Board of Directors prior to filing. Form 990, Part VI, Section B, line 12c The conflict of interest policy is reviewed on an annual basis by the Board of Directors. Board members, officers and management personnel are asked to disclose any potential conflicts. Any potential conflicts are reviewed at that time, and any actual conflicts are noted in the meeting minutes. Any person with a conflict is restricted from voting on related matters. Form 990, Part VI, Section B, line 15 The compensation for the CEO is determined annually by the related organization, Lake Region Healthcare. Form 990, Part VI, Section C, line 19 The Organization's governing documents, conflict of interest policy, and financial statements are available to the public upon request. Form 990 Part VII CEO/CFO Officer Hours The CFO and one of the Interim CEOs were employees of Lake Region Healthcare, a related organization. Due to their time being primarily at LRH, their hours cannot be reasonably allocated between the facilities. The compensation reflected on Part VII is for their services to both organizations. Form 990, Part IX, line 11g Consulting Services: Program service expenses 16,400. Management and general expenses 0. Fundraising expenses 0. Total expenses 16,400. Physician Fees: Program service expenses 2,574,423. Management and general expenses 0. Fundraising expenses 0. Total expenses 2,574,423. Purchased Services: Program service expenses 1,531,021. Management and general expenses 1,033,165. Fundraising expenses 0. Total expenses 2,564,186. Miscellaneous: Program service expenses 27,594. Management and general expenses 14,270. Fundraising expenses 0. Total expenses 41,864. Pharm Care LLC 1411 Highway 79 E Elbow Lake MN 56531 411763968 Retail Pharmacy MN 0 0 Prairie Ridge Hospital and Health Services Inc Prairie Ridge Foundation Inc 1411 Highway 79 E Elbow Lake MN 56531 455092280 Supporting Organization MN 501(c)(3) Line 7 Prairie Ridge Hospital and Health Services Inc 1 Lake Region Healthcare Corporation 712 S Cascade St Fergus Falls MN 565380728 410730602 Hospital MN 501(c)(3) Line 3 N/A 0 Lake Region Healthcare Foundation 712 S Cascade St Fergus Falls MN 565380728 411677288 Foundation MN 501(c)(3) Line 12a, I Lake Region Healthcare Corporation 0 LRHC Long Term Care Facilities Inc 712 S Cascade St Fergus Falls MN 565380728 411817549 Assisted Living MN 501(c)(3) Line 10 Lake Region Healthcare Corporation 0 LRH RAD ONC Services 712 S Cascade St Fergus Falls MN 565380728 271322270 Radiation Oncology Services MN N/A Lake Region Home Medical Supply 712 S Cascade St Fergus Falls MN 565380728 464182501 Medical Equipment Sales MN N/A Lakes Area Community Health Plan 712 S Cascade St Fergus Falls MN 565380728 460952511 Health Insurance Services MN N/A 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0