2017-04-13T14:35:17-05:00 2016-05-31 410746749 CLIFTONLARSONALLEN LLP 220 SOUTH SIXTH STREET SUITE 300 MINNEAPOLIS MN 55402 990 2015-06-01 460391067 PRAIRIE LAKES HEALTH CARE SYSTEM INC PRAI 6058827000 PO BOX 1210 WATERTOWN SD 57201 ADAM PAUL CFO 6058827000 2017-04-11 1 KACIE MCEWEN P01599614 6123764500 2015 2021-01-29 14:40:06Z JILL FULLER PO BOX 1210 WATERTOWN SD 57201 115200125 0 X WWW.PRAIRIELAKES.COM X 1986 SD HEALTH CARE SERVICES 15 14 611 227 915956 233870 150190 148957 81707657 88106837 4933545 9486492 2235220 1899794 89026612 99642080 272202 298013 0 0 40144505 42060895 0 0 0 37547037 41402836 77963744 83761744 11062868 15880336 245720197 247120815 28019321 26785811 217700876 220335004 X PRAIRIE LAKES HEALTH CARE SYSTEM THROUGH THE EFFORTS OF ITS DEDICATED EMPLOYEES AND PHYSICIANS, PROVIDES ACCESSIBLE, HIGH QUALITY, AFFORDABLE, AND COMPASSIONATE HEALTHCARE SERVICES FOR THE PEOPLE IN THE REGION. 0 0 73340653 298013 88106837 PRAIRIE LAKES HEALTHCARE SYSTEM IS A RURAL, REGIONAL MEDICAL CENTER SERVING TEN COUNTIES IN NORTHEASTERN SOUTH DAKOTA AND WESTERN MINNESOTA. THE ORGANIZATION IS COMMITTED TO PROVIDING ACCESSIBLE, HIGH QUALITY, COST-EFFECTIVE HEALTHCARE WHILE EFFECTIVELY MANAGING THE TRANSITION TO NEW PAYMENT AND CARE DELIVERY MODELS. OVER THE PAST DECADE, PLHS SUCCESSFULLY RECRUITED TWENTY-THREE SPECIALTY PHYSICIANS IN ORDER TO BUILD NEW SERVICES THAT WERE NEEDED IN THE REGION. IN THE PAST YEAR, FOUR NEW PHYSICIANS WERE RECRUITED INCLUDING A DERMATOLOGIST, AN EMERGENCY SERVICES PHYSICIAN, A HOSPITALIST AND AN EAR, NOSE & THROAT PHYSICIAN WHO WILL JOIN STAFF IN 2018 FOLLOWING COMPLETION OF RESIDENCY. PLHS ALSO CONTINUED TO INCREASE THE NUMBER OF RURAL OUTREACH CLINICS TO NINETEEN. THESE CLINICS PROVIDE ACCESS TO SPECIALTY PHYSICIANS IN RURAL COMMUNITIES IN THE PLHS SERVICE AREA. DERMATOLOGY SERVICES WERE ADDED TO MEET THE NEEDS OF THE SERVICE AREA. THE FULL-TIME SERVICES SIGNIFICANTLY INCREASED ACCESSIBILITY TO NEEDED DERMATOLOGY CARE. A CLINICAL INTEGRATION INITIATIVE IS NOW IN ITS THIRD YEAR. WORKING WITH COMMUNITY PRIMARY CARE PHYSICIANS, HOSPITAL-BASED PHYSICIANS, AND OTHER POST-ACUTE PROVIDERS, EFFORTS ARE FOCUSED ON IMPROVING PATIENT CARE TRANSITIONS FROM ONE SETTING TO ANOTHER AND BUILDING CARE MANAGEMENT PROTOCOLS TO ENSURE OPTIMAL CLINICAL OUTCOMES WHILE DECREASING THE TOTAL COST OF CARE. INCLUDED IN THESE CLINICAL INTEGRATION ACTIVITIES WERE THE FOLLOWING SPECIAL PROJECTS: 1. HOSPITAL-NURSING HOME CARE TRANSITIONS DESIGNED TO IMPROVE THE HANDOFF OF PATIENT INFORMATION DURING THE TRANSFER FROM ACUTE CARE TO SKILLED CARE TO DECREASE ERRORS AND TO DECREASE HOSPITAL READMISSIONS; 2. JOINT JOURNEY TO ENGAGE PATIENTS SCHEDULED FOR TOTAL JOINT REPLACEMENT WITH A SUPPORT GROUP, PROVIDE PATIENT AND FAMILY EDUCATION, AND PROVIDE PRE-OPERATIVE EXERCISE TRAINING. SUCH PROGRAMS RESULT IN IMPROVED RECOVERY, BETTER POST-OPERATIVE PAIN CONTROL, AND DECREASE THE TOTAL COST OF CARE; 3. DIABETIC SUPPORT GROUPS WERE ESTABLISHED THROUGH FINANCIAL SUPPORT FROM PLHS. IMPROVING DIABETIC HEALTH WAS A PRIORITY IDENTIFIED IN THE ORGANIZATION'S COMMUNITY HEALTH NEEDS ASSESSMENT; AND, 4. THE HOME TRANSITION PROGRAM THAT PROVIDES HIGH-RISK, RECENTLY DISCHARGED PATIENTS WITH A COMPLIMENTARY POST-DISCHARGE VISIT BY A REGISTERED NURSE. THIS SERVICE FILLS A GAP IN THE CARE OF PEOPLE WITH HEART FAILURE AND OTHER DISEASES. THE ORGANIZATION'S COMMITMENT TO IMPROVING QUALITY AND PATIENT OUTCOMES WAS ACKNOWLEDGED BY THE RECEIPT OF AWARDS BASED ON REVIEW OF PUBLICALLY REPORTABLE DATA. FOR THE THIRD CONSECUTIVE YEAR, PLHS RECEIVED THE AMERICAN COLLEGE OF CARDIOLOGY FOUNDATION'S NCDR ACTION REGISTRY - PLATINUM PERFORMANCE ACHIEVEMENT AWARD. THE AWARD RECOGNIZED CONSISTENT ADHERENCE TO RECOMMENDED TREATMENT GUIDELINES FOR CARDIOLOGY PATIENTS AND PERFORMANCE AT THE 90TH PERCENTILE ON SELECTED PERFORMANCE MEASURES. IN JANUARY, 2016, PLHS WAS NAMED A RECIPIENT OF THE WOMEN'S CHOICE AWARD AS AMERICA'S BEST HOSPITALS FOR EMERGENCY CARE FOR THE THIRD YEAR IN A ROW. IN MARCH, 2016 PLHS RECEIVED THE RECOGNITION OF BEING ONE OF THE TOP 100 RURAL & COMMUNITY HOSPITALS IN THE US BY IVANTAGE HEALTH ANALYTICS AND THE CHARTIS CENTER FOR RURAL HEALTH. IVANTAGE'S INDEX MEASURES HOSPITALS ACROSS EIGHT PILLARS OF HOSPITAL STRENGTH: INPATIENT SHARE RANKING, OUTPATIENT SHARE RANKING, COST, CHARGE, QUALITY, OUTCOMES, PATIENT PERSPECTIVES, AND FINANCIAL STABILITY. IN SUMMARY, PLHS ACHIEVES ITS HEALTHCARE MISSION IN THREE WAYS: FIRST, BY OPERATING A COMMUNITY HOSPITAL WITH ESSENTIAL SERVICES INCLUDING OBSTETRICS, EMERGENCY SERVICES, INPATIENT MEDICAL SERVICES AND OUTPATIENT SERVICES. SECOND, PLHS PROVIDES RURAL SPECIALTY OUTREACH WITH EMPHASIS ON DIALYSIS, HOME HEALTH, REHABILITATION SERVICES AND OUTREACH CLINICS THAT ALLOW PEOPLE TO SEE SPECIALISTS IN THEIR COMMUNITIES. THIRD, PLHS PROVIDES SPECIALTY MEDICAL AND SURGICAL CARE TO A TEN-COUNTY SERVICE AREA. 73340653 1 1 0 0 0 0 0 0 0 0 1 0 0 0 1 1 0 1 0 0 0 0 0 0 0 0 1 1 1 0 1 1 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 1 1 1 0 0 1 89 0 611 1 1 1 0 0 0 0 0 0 0 0 0 X 15 14 0 0 0 0 0 0 0 1 1 0 0 0 1 1 1 1 1 1 0 0 X ADAM PAUL 6058827000 401 9TH AVENUE NW WATERTOWN SD 57201 MARK ROBY BOARD CHAIR 1.00 X X 0 0 0 JIM REDLINGER VICE CHAIR 1.00 X X 0 0 0 DOUGLAS SHARP SECRETARY 1.00 1.00 X X 0 0 0 DUSTIN FLATTEN BOARD TREASURER 1.00 1.00 X X 0 0 0 MONTE HOPPER PAST CHAIR 1.00 X 0 0 0 JOHN CALVIN BOARD MEMBER 1.00 X 0 0 0 ALAN CHRISTENSEN MD BOARD MEMBER 1.00 X 0 0 0 VINCE FOLEY BOARD MEMBER 1.00 X 0 0 0 CATHERINE GERRISH MD BOARD MEMBER 1.00 X 0 0 0 BERNIE HANSON MD BOARD MEMBER 1.00 X 0 0 0 SHANNON KRUSE BOARD MEMBER 1.00 X 0 0 0 TOM LABRIE BOARD MEMBER 1.00 X 0 0 0 ROBB PETERSON BOARD MEMBER 1.00 X 0 0 0 GERALD RIEBER MD BOARD MEMBER 1.00 X 0 0 0 LUANN STRAIT BOARD MEMBER 1.00 1.00 X 0 0 0 JILL FULLER CEO 40.00 1.00 X 556634 0 46606 ADAM PAUL CFO 40.00 X 303687 0 34093 MICHAEL ANDERSON CHIEF INVESTMENT OFFICER 40.00 X 409390 0 41835 NATE LAKE VICE PRESIDENT 40.00 1.00 X 219649 0 33883 TRACI RABINE VICE PRESIDENT 40.00 X 214511 0 35333 MICHELE TURBAK CHIEF NURSING OFFICER 40.00 X 179686 0 35679 GRANT TILLETT CHIEF INFORMATION OFFICER 40.00 X 179686 0 20141 EVELIO GARCIA PHYSICIAN 40.00 X 1175937 0 32126 SALEM MAALIKI PHYSICIAN 40.00 X 1002754 0 32126 JENNIFER JONES PHYSICIAN 40.00 X 642500 0 18355 JEFFREY BRINDLE PHYSICIAN 40.00 X 548953 0 32126 BIPIN AMIN PHYSICIAN 40.00 X 635051 0 26386 6068438 0 388689 39 0 1 0 COMPHEALTH PO BOX 972651 DALLAS TX 75397 LOCUM PHYSICIANS 842040 WMG DAKOTA LLCSUMMIT STEGLITS 107 FLYNN DRIVE STE 600 MILBANK SD 57252 LOCUM ER PHYSICIANS 499335 DR EW FILLER MD PC 21804 468TH AVE VOLGA SD 57006 ER/MD COVERAGE 344752 PRECISION DIAGNOSTIC SERVICE INC 4152 30TH AVE S STE 103 FARGO ND 58104 SLEEP STUDIES 335675 FEKA HEMATOLOGY ONCOLOGY 300 WEST CENTURY AVE BISMARCK ND 58503 ONCOLOGY MD 324800 16 148957 148957 NET PATIENT SERVICE REVENUE 621400 87190881 87190881 RETAIL PHARMACY 446110 793010 793010 LAB SERVICE 621500 122946 122946 88106837 570736 570736 928449 0 928449 928449 928449 24470133 3668 15558045 0 8912088 3668 8915756 8915756 EHR INCENTIVE PAYMENT 900099 352843 352843 OTHER INCOME 900099 297216 297216 CAFETERIA REVENUE 722210 285415 285415 35871 35871 971345 99642080 87190881 915956 11386286 298013 298013 1803635 1803635 34075775 30554834 3520941 745947 745947 3108811 2913254 195557 2326727 2031815 294912 79132 79132 63700 63700 7033302 6105281 928021 342757 342757 1678772 1118753 560019 548279 35781 512498 855056 17390 837666 397668 281739 115929 233779 89906 143873 533047 533047 4629927 4265257 364670 371013 371013 UBI TAXES 90000 90000 MEDICAL SUPPLIES 10660403 10660403 DRUGS 7480829 7480829 PROVISION FOR BAD DEBT 3408761 3408761 2996411 2428630 567781 83761744 73340653 10421091 0 1876 2026 7616545 7546784 8842182 9327184 521349 390523 1637136 2026580 510027 780324 113090263 66037034 48494941 47053229 165222164 165900189 6394069 6255139 421778 377526 6058130 7461311 245720197 247120815 12161903 12887305 12276546 10040709 3580872 3857797 28019321 26785811 X 213810605 216470980 3890271 3864024 217700876 220335004 245720197 247120815 X 15880336 -13213672 -6289 -26247 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 2608895 2608895 47357796 21776078 25581718 2665343 1753385 911958 59826322 42507571 17318751 631907 631907 47053229 457(B) PAYABLE 3210473 LONG-TERM PTO 555424 ASBESTOS PAYABLE 91900 3857797 X PART X, LINE 2: THE INTERNAL REVENUE SERVICE (IRS) HAS DETERMINED THAT PRAIRIE LAKES AND HOME CONNECTIONS ARE TAX-EXEMPT, NOT-FOR-PROFIT CORPORATIONS 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. 1 1 X 1 X 1 X 1 1 1 0 1 1 1514000 1514000 0.01880 3718619 2205398 1513221 0.01880 5232619 2205398 3027221 0.03760 131233 131233 0.00160 12370392 6229964 6140428 0.07640 316538 316538 0.00390 12818163 6229964 6588199 0.08190 18050782 8435362 9615420 0.11950 1 3408761 0 31381810 29167769 2214041 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 15 1 0 0 1 X WWW.PRAIRIELAKES.COM/IMAGES/PDFS/2016_COMMUNITY_NEEDS_ASSESSMENT_-_FINAL.PD X 1 15 1 WWW.PRAIRIELAKES.COM/IMAGES/PDFS/2016_COMMUNITY_NEEDS_ASSESSMENT_-_FINAL.PD 0 0 1 X 150.000000000000 200.000000000000 X X X X 1 1 X X X 1 X HTTPS://WWW.PRAIRIELAKES.COM/PATIENT-INFORMATION/FINANCIAL-ASSISTANCE-PROGR X HTTPS://WWW.PRAIRIELAKES.COM/PATIENT-INFORMATION/FINANCIAL-ASSISTANCE-PROGR X HTTPS://WWW.PRAIRIELAKES.COM/PATIENT-INFORMATION/FINANCIAL-ASSISTANCE-PROGR X X X X X 1 X 0 X X X X 1 X 0 0 PRAIRIE LAKES HEALTH CARE SYSTEM PART V, SECTION B, LINE 5: A COMPREHENSIVE, DATA DRIVEN ASSESSMENT WAS USED TO IDENTIFY COMMUNITY HEALTH NEEDS. PLHS UTILIZED A TWO-STEP PROCESS TO COLLECT PRIMARY AND SECONDARY DATA. IN STEP ONE, PLHS SOLICITED INPUT FROM COMMUNITY HEALTH STAKEHOLDERS INCLUDING PUBLIC HEALTH PROFESSIONALS; SERVICE AGENCIES ASSISTING VULNERABLE, LOW-INCOME, AND MINORITY POPULATIONS; HEALTHCARE PROVIDERS; AND, GOVERNMENT AND PUBLIC SAFETY OFFICIALS. IN ORDER TO ADDRESS NEEDS OF THE ENTIRE "COMMUNITY," STAKEHOLDERS INCLUDED INDIVIDUALS FROM OUTSIDE THE PRIMARY SERVICE AREA OF PLHS. INPUT WAS OBTAINED THROUGH TWO FOCUS GROUP SESSIONS AND KEY INFORMANT INTERVIEWS. STEP TWO CONSISTED OF EVALUATION OF DATA RELATED TO DEMOGRAPHICS AND HEALTH FROM THE UNITED STATES CENSUS BUREAU, SOUTH DAKOTA DEPARTMENT OF HEALTH, SOUTH DAKOTA ASSOCIATION OF HEALTHCARE ORGANIZATIONS, MINNESOTA DEPARTMENT OF HEALTH AND OTHER SOURCES. PRAIRIE LAKES HEALTH CARE SYSTEM PART V, SECTION B, LINE 11: 1. MENTAL HEALTHOBJECTIVE:IMPROVE ACCESS TO MENTAL HEALTH SERVICES THROUGH PARTNERSHIPS WITH OTHER HEALTHCARE PROVIDERS TO FACILITATE IMPROVED ACCESS TO CARE.KEY INITIATIVES:A. DEVELOP THE INFRASTRUCTURE NEEDED TO IDENTIFY SPECIFIC NEEDS AND SOLUTIONSB. SEEK OUT COLLABORATION OPPORTUNITIES TO INCREASE ACCESS2. ACCESS TO HEALTHCARE - TRANSPORTATIONOBJECTIVES:DECREASES BARRIERS TO HEALTH CARE ACCESS RELATED TO TRANSPORTATION. KEY INITIATIVES:A. SUSTAIN PARTNERSHIP WITH WATERTOWN AREA TRANSIT PROVIDING FREE RIDE SERVICE TO MEDICAL APPOINTMENTSB. EXPLORE OPTIONS FOR INCREASED MARKETING AND DISSEMINATION OF INFORMATION TO INCREASE AWARENESS OF PUBLIC TRANSPORTATION OPTIONS3. CHRONIC DISEASE MANAGEMENTOBJECTIVE:IMPROVE QUALITY OF LIFE AND CLINICAL OUTCOMES FOR PEOPLE WITH CHRONIC DISEASE.KEY INITIATIVES:A. CARDIOVASCULAR DISEASE: - CONTINUE TO ENHANCE HOME TRANSITIONS PROGRAM 34 - ENHANCE PATIENT EDUCATIONB. DIABETES: - CONTINUE TO ENHANCE HOME TRANSITIONS PROGRAM - EXPLORE THE NEED FOR DIABETIC SPECIFIC TRAINED STAFFC. RESPIRATORY DISEASE: - CONTINUE TO ENHANCE HOME TRANSITIONS PROGRAM - RECRUIT A PULMONOLOGIST - REINSTATE OUTREACH CLINICSD. CEREBROVASCULAR DISEASE (STROKE): - ENHANCE PATIENT EDUCATION - EVALUATE STROKE PROTOCOLS4. HEALTH LITERACYOBJECTIVE:IMPROVE MEDICATION SAFETY FOR THE COMMUNITY.KEY INITIATIVES:A. DEVELOP THE INFRASTRUCTURE NEEDED TO PROVIDE PUBLIC EDUCATIONB. EXPLORE THE DEVELOPMENT OF MEDICATION PROTOCOLS FOR SELECT HEALTH CONDITIONS PRAIRIE LAKES HEALTH CARE SYSTEM PART V, SECTION B, LINE 22D: THE HOSPITAL USED THE CRITERIA SET FORTH IN ITS FINANCIAL ASSISTANCE POLICY TO DETERMINE THE LEVEL OF DISCOUNT FOR PATIENTS QUALIFYING FOR ASSISTANCE. THE HOSPITAL USES THE MOST RECENTLY COMPLETED FISCAL YEAR'S AVERAGE PAYMENT PERCENT OF GROSS BILLED CHARGES PAID ON CLAIMS FOR PATIENTS THAT HAVE MEDICARE, MEDICAID, OR PRIVATE INSURANCE. 4 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 4 - PRAIRIE LAKE PULMONOLOGY CLINIC 600 4TH STREET NE WATERTOWN SD 57201 PULMONOLOGY CLINIC 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 CONIDERED 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 ARE CALCULATED USING A COST TO CHARGE RATIO DERIVED INTERNALLY USING THE HEALTH SYSTEM'S OVERALL COST TO CHARGE RATIO. PART I, LINE 7G: THE SUBSIDIZED HEALTH SERVICES INCLUDED IN SCHEDULE H, PART I, LINE 7G RELATES TO THE EMERGENCY ROOM, CARDIOLOGY CLINIC, ONCOLOGOY CLINIC, NEPHROLOGY CLINIC, UROLOGY CLINIC, PULMONOLOGY CLINIC, AND ENT CLINIC. PART I, LN 7 COL(F): $3,408,761 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 DEVELOPMENT COMPANY WHICH WORKS TO BRING NEW BUSINESSES TO WATERTOWN, JOY RANCH WHICH PROVIDES CAMP EXPERIENCE TO DISABLED CHILDREN, LAKE AREA TECHNICAL INSTITUTE WHICH PROVIDES EDUCATION AND TRAINING FOR HEALTH PROFESSIONALS, THE BOYS AND GIRLS CLUB WHICH PROVIDES RESOURCES FOR COMMUNITY YOUTH. 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: THE FINANCIAL STATEMENTS DO NOT CONTAIN A FOOTNOTE PERTAINING TO BAD DEBT EXPENSE SPECIFICALLY. HOWEVER, WITHIN NOTE 1, "PATIENT ACCOUNTS RECEIVABLE", THE PROVISION FOR BAD DEBTS IS REFERENCED. THIS NOTE IS INCLUDED ON PAGE 8 OF THE 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 2016 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 36,000. IT'S SECONDARY SERVICE AREA COVERS 4 COUNTIES IN SOUTH DAKOTA AND 3 COUNTIES IN MINNESOTA WITH A POPULATION OF 54,000. PART VI, LINE 5: THE ORGANIZATION OFFERS FREE HEALTH SEMINARS 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 INSTITUTE AND TWO STATE UNIVERSITIES TO HELP TRAIN MEDICAL STUDENTS. THE ORGANIZATION IS DEDICATED TO IMPLEMENTING AND MAINTAINING THE MOST CURRENT TECHNOLOGY IN PROVIDING CARE. 1 BOYS & GIRLS CLUB OF WATERTOWN PO BOX 833 WATERTOWN SD 57201 460311845 501(C)(3) 125000 CAPITAL CAMPAIGN BUILDING PROJECT WATERTOWN UNITED WAY PO BOX 283 WATERTOWN SD 57201 460359557 501(C)(3) 31000 COMMUNITY ORGANIZATION FUNDING LAKE AREA KIDNEY ENDOWMENT 901 4TH AVE NW WATERTOWN SD 57201 474601728 501(C)(3) 10000 RESEARCH AND SCREENINGS SANFORD CLINIC 901 4TH ST NW WATERTOWN SD 57201 460447693 501(C)(3) 10000 FAMILY PLANNING CLINIC LAKE ARE TECHNICAL INSTITUTE PO BOX 730 WATERTOWN SD 57201 460381673 501(C)(3) 8001 SCHOLARSHIPS HUMAN SERVICE AGENCY PO BOX 1030 WATERTOWN SD 57201 460275247 501(C)(3) 6000 DETOX FUNDING WATERTOWN DEVELOPMENT CORP PO BOX 1267 WATERTOWN SD 57201 466012194 501(C)(6) 35000 COMMUNITY DEVELOPMENT LUTHERAN OUTDOORS IN SD 2001 S SUMMIT AVE SIOUX FALLS SD 57197 460320561 501(C)(3) 6000 CAMP SPONSORSHIP 8 0 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 0 0 0 0 0 0 0 0 0 JILL FULLER CEO 392434 0 164200 0 0 0 22430 0 24176 0 603240 0 0 0 ADAM PAUL CFO 234591 0 69096 0 0 0 16793 0 17300 0 337780 0 0 0 MICHAEL ANDERSON CHIEF INVESTMENT OFFICER 284390 0 125000 0 0 0 18975 0 22860 0 451225 0 0 0 NATE LAKE VICE PRESIDENT 163882 0 55767 0 0 0 11023 0 22860 0 253532 0 0 0 TRACI RABINE VICE PRESIDENT 158752 0 55759 0 0 0 12473 0 22860 0 249844 0 0 0 MICHELE TURBAK CHIEF NURSING OFFICER 123087 0 56599 0 0 0 12819 0 22860 0 215365 0 0 0 GRANT TILLETT CHIEF INFORMATION OFFICER 137760 0 41926 0 0 0 5299 0 14842 0 199827 0 0 0 EVELIO GARCIA PHYSICIAN 1100937 0 75000 0 0 0 7950 0 24176 0 1208063 0 0 0 SALEM MAALIKI PHYSICIAN 1002754 0 0 0 0 0 7950 0 24176 0 1034880 0 0 0 JENNIFER JONES PHYSICIAN 642500 0 0 0 0 0 7950 0 10405 0 660855 0 0 0 JEFFREY BRINDLE PHYSICIAN 548953 0 0 0 0 0 7950 0 24176 0 581079 0 0 0 BIPIN AMIN PHYSICIAN 610051 0 25000 0 0 0 7950 0 18436 0 661437 0 0 0 A SOUTH DAKOTA HEALTH AND EDUCATIONAL FACILITIES AUTHORITY 460315509 83755VRN6 2010-12-08 21672812 CURRENT REFUNDING OF SERIES 1998 BONDS & ADVANCE REFUNDING OF SERIES 2002 0 0 0 A 12037812 25166290 3303 431508 24731480 2010 1 1 1 1 A 0 0 0 1 0 0 0 0 1 A 1 DATE REBATE COMPUTATION PERFORMED ISSUER NAME: SOUTH DAKOTA HEALTH AND EDUCATIONAL FACILITIES AUTHORITY DATE THE REBATE COMPUTATION WAS PERFORMED: 04/01/2013 SCHEDULE K, PART II, LINE 3 THE DIFFERENCE IN THE ISSUANCE PRICE INCLUDED IN PART I, LINE A, COLUMN E OF $21,672,812 IS DIFFERENT THAN THE TOTAL PROCEEDS OF ISSUANCE INCLUDED IN PART II, LINE 3 OF $25,166,290 BECAUSE OF THE TRUSTEE FUNDS UTILIZED DURING THE REFINANCING. GREGORY GERRISH MD TRUSTEE OF PLHS, CATHY GERRISH, IS THE MOTHER OF GREGORY GERRISH, MD 50000 PLHS PAID A RESIDENCY STIPEND TO GREGORY GERRISH, MD. 0 FORM 990, PART VI, SECTION A, LINE 1 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 11 EXECUTIVE MANAGEMENT REVIEWED THE FORM 990 IN DETAIL. THEY THEN PRESENTED THE FORM 990 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 ON AN ANNUAL BASIS. THAT STATEMENT DISCLOSES ANY AREAS THAT MAY HAVE A POTENTIAL FOR CONFLICT OF INTEREST WITH THEMSELVES OR FAMILY MEMBERS. THE CONFLICT OF INTEREST POLICY IS MONITORED BY THE CEO AND THE BOARD. AT BOARD MEETINGS, THE MEMBERS WILL EXCUSE THEMSELVES FROM ANY DISCUSSION OR VOTING ON AN ISSUE WHERE A CONFLICT MAY EXIST. FORM 990, PART VI, SECTION B, LINE 15A COMPENSATION COMPARABILITY STUDIES ARE REVIEWED EACH YEAR FOR ALL POSITIONS. THE COMPENSATION STUDIES ARE CONDUCTED INTERNALLY BY THE HUMAN RESOURCES DEPARTMENT. THE HUMAN RESOURCES DEPARTMENT HAS ACCESS TO VARIOUS COMPENSATION SURVEYS WHICH THEY REVIEW IN ORDER TO DETERMINE IF THE HOSPITAL'S COMPENSATION IS REASONABLE COMPARED TO OTHER FACILITIES. THE LAST COMPENSATION STUDY WAS PERFORMED IN 2012. THE BOARD APPROVES SALARY OF THE CEO THROUGH ITS EXECUTIVE COMMITTEE SERVING AS THE COMPENSATION COMMITTEE. THE BOARD DELEGATES VICE PRESIDENT EXECUTIVE COMPENSATION APPROVAL TO CEO BASED ON THE ORGANIZATION'S COMPENSATION PHILOSOPHY IN CONJUNCTION WITH MARKET BENCHMARKS. FORM 990, PART VI, SECTION C, LINE 19 FINANCIAL STATEMENTS ARE AVAILABLE THROUGH FILINGS WITH BONDING AUTHORITY. THE ORGANIZATION DOES NOT MAKE ITS GOVERNING DOCUMENTS AND CONFLICT OF INTEREST POLICY AVAILABLE TO THE PUBLIC. FORM 990, PART XI, LINE 9: CHANGE IN BENEFICIAL INTEREST IN PRAIRIE LAKES FOUNDATION -26,247. PRAIRIE LAKES HOME CONNECTIONS INC 401 9TH AVE NW WATERTOWN SD 57201 460394984 HOMEMAKER & NURSING SERVICES SD 501(C)(3) LINE 9 PRAIRIE LAKES HEALTH CARE SYSTEM INC 1 0 0 0 0 0 0 0 0 0 1 0 1 1 1 1 0 1 0 0 PRAIRIE LAKES HOME CONNECTIONS INC L 92533 GAAP PRAIRIE LAKES HOME CONNECTIONS INC O 101346 GAAP