2016-04-11T17:14:45-05:00 2015-05-31 410746749 CLIFTONLARSONALLEN LLP 220 SOUTH SIXTH STREET SUITE 300 MINNEAPOLIS MN 55402 990 2014-06-01 460391067 PRAIRIE LAKES HEALTH CARE SYSTEM INC PRAI 6058827000 PO BOX 1210 WATERTOWN SD 57201 ADAM PAUL CFO 6058827000 2016-04-07 1 KACIE MCEWEN P01599614 6123764500 2014 2016-08-17 19:52:53Z JILL FULLER PO BOX 1210 WATERTOWN SD 57201 98399861 0 X WWW.PRAIRIELAKES.COM X 1986 SD HEALTH CARE SERVICES 15 14 593 198 882523 0 55328 150190 79389439 81707657 9496857 4933545 2775855 2235220 91717479 89026612 155483 272202 0 0 38855388 40144505 0 0 0 36984502 37547037 75995373 77963744 15722106 11062868 234746435 245720197 29373739 28019321 205372696 217700876 X PRAIRIE LAKES HEALTH CARE SYSTEM THROUGH THE EFFORTS OF ITS DEDICATED EMPLOYEES AND PHYSICIANS, PROVIDES HIGH QUALITY, AFFORDABLE AND COMPASSIONATE HEALTHCARE SERVICES FOR THE PEOPLE IN THE REGION. 0 0 68233540 272202 81619225 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, THREE NEW PHYSICIANS WERE RECRUITED INCLUDING A MEDICAL ONCOLOGIST AND TWO GENERAL SURGEONS WHO WILL JOIN THE MEDICAL STAFF IN 2016 FOLLOWING COMPLETION OF RESIDENCY. PLHS ALSO CONTINUED TO INCREASE THE NUMBER OF RURAL OUTREACH CLINICS FROM FOURTEEN TO EIGHTEEN. THESE CLINICS PROVIDE ACCESS TO SPECIALTY PHYSICIANS IN RURAL COMMUNITIES IN THE PLHS SERVICE AREA. THREE NEW SERVICES WERE ADDED TO MEET THE NEEDS OF THE SERVICE AREA. PULMONARY REHABILITATION SERVICES WERE DEVELOPED AND MADE AVAILABLE WITH THE ADDITION OF A FULL TIME PULMONOLOGIST IN THE COMMUNITY IN THE PRIOR YEAR. THE NEED FOR THIS SERVICE HAS BEEN CONSISTENTLY IDENTIFIED IN THE ORGANIZATION'S COMMUNITY HEALTH NEEDS ASSESSMENT. A NEW PERIPHERAL VASCULAR SCREENING PROGRAM WAS DEVELOPED TO PROMOTE EARLY INTERVENTION IN HIGH RISK PATIENTS. WOUND CARE SERVICES WERE SIGNIFICANTLY ENHANCED BY DEVELOPING ADVANCED PROTOCOLS AND AN INTERDISCIPLINARY TEAM APPROACH TO TREATMENT. WOUND CARE SERVICES ARE ALSO OFFERED TO RESIDENTS OF THE TWO LONG-TERM CARE FACILITIES IN THE COMMUNITY. A CLINICAL INTEGRATION INITIATIVE IS NOW IN ITS THIRD YEAR. WORKING WITH COMMUNITY PRIMARY CARE PHYSICIANS, HOSPITALS-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 SECOND 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 APRIL 2015, PLHS WAS NAMED A RECIPIENT OF THE WOMEN'S CHOICE AWARD AS AMERICA'S BEST HOSPITALS FOR EMERGENCY CARE FOR THE SECOND YEAR IN A ROW. THIS CREDENTIAL PLACES PRAIRIE LAKES' PERFORMANCE IN THE TOP FIVE PERCENT FOR EMERGENCY CARE, WHICH WAS ACHIEVED BY 373 HOSPITALS OF THE 3,800 HOSPITALS REPORTING DATA TO THE CENTERS FOR MEDICARE AND MEDICAID.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. 68233540 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 0 0 0 1 71 0 593 1 1 1 0 0 0 0 0 0 0 0 0 X 15 14 0 0 1 0 0 0 0 1 1 0 0 0 1 1 1 1 1 1 1 0 X ADAM PAUL 6058827000 401 9TH AVENUE NW WATERTOWN SD 57201 MARK ROBY BOARD CHAIR 1.00 X X 0 0 0 GEOFF HEIG BOARD VICE CHAIR 1.00 X X 0 0 0 JIM REDLINGER BOARD SECRETARY 1.00 X X 0 0 0 DUSTIN FLATTEN BOARD TREASURER 1.00 X X 0 0 0 MONTE HOPPER PAST BOARD 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 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 DOUGLAS SHARP BOARD MEMBER 1.00 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 570500 0 44994 ADAM PAUL CFO 40.00 X 275565 0 31709 MICHAEL ANDERSON CHIEF INVESTMENT OFFICER 40.00 X 378375 0 40336 NATE LAKE VICE PRESIDENT 40.00 1.00 X 201763 0 32465 TRACI RABINE VICE PRESIDENT 40.00 X 193490 0 32214 MICHELE TURBAK CHIEF NURSING OFFICER 40.00 X 203419 0 32702 GRANT TILLETT CHIEF INFORMATION OFFICER 40.00 X 0 0 0 CHRIS ADDUCCI MD PHYSICIAN 40.00 X 650000 0 30733 BIPINKUMAR AMIN MD PHYSICIAN 40.00 X 610000 0 25267 EVELIO GARCIA MD PHYSICIAN 40.00 X 1175008 0 30733 SALEM MAALIKI MD PHYSICIAN 40.00 X 1002753 0 30733 JENNIFER JONES PHYSICIAN 40.00 X 642500 0 17619 5903373 0 349505 35 0 1 0 WMG DAKOTA LLCSUMMIT STEGLITS 107 FLYNN DRIVE STE 600 MILBANK SD 57252 LOCUM ER PHYSICIANS 395455 WEATHERBY LOCUMS PO BOX 972633 DALLAS TX 75397 ER/MD/ONCOLOGY COVERAGE 364836 DR EW FILLER MD PC 21804 468TH AVE VOLGA SD 57006 ER/MD COVERAGE 344340 PDS INC 4152 30TH AVE S STE 103 FARGO ND 58104 SLEEP STUDIES 335675 MARK VOSSLER MD 47241 180TH ST CLEAR LAKE SD 57226 ER/HOSPITALIST 244549 11 150190 150190 NET PATIENT SERVICE REVENUE 621400 80826949 80826949 RETAIL PHARMACY 446110 816711 816711 LAB SERVICE 621500 63997 63997 81707657 502769 502769 918790 0 918790 918790 918790 13504025 300000 9025809 347440 4478216 -47440 4430776 4430776 EHR INCENTIVE PAYMENT 900099 827447 827447 CAFETERIA REVENUE 722210 263663 263663 OTHER INCOME 900099 191726 191726 33594 1815 31779 1316430 89026612 80826949 882523 7166950 272202 272202 1801483 1801483 31973758 29008991 2964767 739375 739375 3385937 3211521 174416 2243952 1981010 262942 224786 224786 61135 61135 5412724 4475092 937632 279962 53 279909 1479319 890687 588632 453948 22457 431491 938951 17034 921917 385239 288966 96273 215751 82362 133389 611217 611217 4595109 4315989 279120 345207 345207 MEDICAL SUPPLIES 9584081 9584081 DRUGS 7697364 7697364 PROVISION FOR BAD DEBT 2464541 2464541 EQUIP RENT/MAINTENANCE 1694058 1665581 28477 1103645 559810 543835 77963744 68233540 9730204 0 1626 1876 9402972 7616545 8914210 8842182 261301 521349 1499071 1637136 503912 510027 110100046 61605105 49038957 48494941 153988709 165222164 6243565 6394069 466030 421778 4426082 6058130 234746435 245720197 11923375 12161903 14412383 12276546 3037981 3580872 29373739 28019321 X 201613434 213810605 3759262 3890271 205372696 217700876 234746435 245720197 X 11062868 1145153 -10850 131009 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 2341520 2341520 46975259 20430936 26544323 2656954 1655802 1001152 58117443 39518367 18599076 8870 8870 48494941 457(B) PAYABLE 2970733 LONG-TERM PTO 518239 ASBESTOS PAYABLE 91900 3580872 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 2323000 2323000 0.03080 3646827 2033745 1613082 0.02140 5969827 2033745 3936082 0.05220 133488 133488 0.00180 10580317 5987507 4592810 0.06080 99391 99391 0.00130 10813196 5987507 4825689 0.06390 16783023 8021252 8761771 0.11610 49000 49000 0.00060 49000 49000 0.00060 1 2464541 0 28500475 27316907 1183568 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 12 1 0 0 1 X HTTP://WWW.PRAIRIELAKES.COM/PDF/FY2013_CHNA_FINAL.PDF X 1 12 0 0 0 1 X 150.000000000000 200.000000000000 X X X X 1 1 X X X 1 X HTTP://WWW.PRAIRIELAKES.COM/IMAGES/PDFS/PLHS_FINANCIAL_ASSISTANCE_POLICY.PD X HTTP://WWW.PRAIRIELAKES.COM/IMAGES/PDFS/FINANCIAL_ASSISTANCE_APPLICATION.PD X HTTP://WWW.PRAIRIELAKES.COM/PATIENT-VISITOR-SERVICES/FINANCIAL-ASSISTANCE-P X X X X X 1 0 X X X X 1 X 0 0 PRAIRIE LAKES HEALTH CARE SYSTEM PART V, SECTION B, LINE 5: PRAIRIE LAKES HELD TWO FOCUS GROUPS WITH COMMUNITY AND HEALTH LEADERS AS WELL AS CONDUCTED SEVERAL INTERVIEWS TO DETERMINE THE LEADING HEALTH ISSUES AND PRIORITIES. IN ADDITION, PRAIRIE LAKES PARTNERED WITH HEALTHSTREAM, INC., A COMMUNITY PERCEPTION RESEARCHER, TO CONDUCT A COMMUNITY SURVEY. IN JUNE 2012, PRAIRIE LAKES HELD TWO FOCUS GROUPS TO SEEK THE INPUT OF COMMUNITY AND HEALTHCARE LEADERS. THE GOAL OF THESE FOCUS GROUPS WAS TO IDENTIFY UNMET HEALTHCARE NEEDS, UNDERSERVED POPULATIONS, AND LIMITED ACCESS TO CARE IN THE REGION. TO ENSURE ALL POPULATIONS AND INTERESTS WERE REPRESENTED, PRAIRIE LAKES CONTACTED KEY COMMUNITY AND HEALTH LEADERS WHO WERE UNABLE TO ATTEND EITHER FOCUS GROUP OR PERSONAL INTERVIEWS.IN JULY AND AUGUST 2012, PRAIRIE LAKES PARTNERED WITH HEALTHSTREAM, INC. TO CONDUCT A COMMUNITY INSIGHTS COMMUNITY NEEDS ASSESSMENT OF PRAIRIE LAKES' PRIMARY AND SECONDARY SERVICE AREAS. TO COMPLETE THE RESEARCH OBJECTIVES, 506 CONSUMERS WERE SURVEYED OVER THE TELEPHONE. SURVEYS WERE COMPLETED WITH RESIDENTS 18 YEARS OF AGE OR OLDER. ONLY RESIDENTS LIVING IN DEFINED ZIP CODES WERE ELIGIBLE TO COMPLETE THE SURVEY. PRAIRIE LAKES HEALTH CARE SYSTEM PART V, SECTION B, LINE 11: WAYS IN WHICH THE ORGANIZATION IS ADDRESSING THE FOLLOWING HEALTH NEEDS ARE AS FOLLOWS: 1. CARDIOVASCULAR DISEASE:THERE IS A HIGHER INCIDENCE OF CARDIOVASCULAR DISEASE IN THE SERVICE AREA THAN THE OVERALL STATE INCIDENCE. HEART DISEASE IS ASSOCIATED WITH PREMATURE DEATH. AS A RESULT, PLHS IMPLEMENTED THE FOLLOWING PROGRAMS WITHIN THEIR ORGANIZATION: - IMPLEMENTED BEDSIDE EDUCATION FOR ALL CHF ADMISSIONS (CR NURSE AND DIETICIAN) - HOME TRANSITION PROGRAM- COMPLIMENTARY VISIT TO PATIENTS DISCHARGED WITH CHF DIAGNOSIS THAT GO HOME WITH NO OTHER ASSISTANCE - CARDIOMEMS AND REMOTE MONITORING TECHNOLOGY BECAME AVAILABLE APRIL 2015(IMPACT: QUALITY OF CARE, EARLY INTERVENTION, FREES UP PHYSICIAN TIME TO INCREASE ACCESS, AND DECREASES OVERALL COST OF CARE.) - GENERAL EDUCATION TO THE COMMUNITY AND IN BUSINESSES (LUNCH, LADIES NIGHT OUT) - NURSING HOME AND ASSISTED LIVING EDUCATION (POST CARE AND EDUCATION ON PACEMAKERS, ICD, REMOTE MONITORING, CHF) - IMPLEMENTED VASCULAR SCREENINGS ON CARDIAC PATIENTS DUE TO HIGH CORRELATION MEASURE: CHF READMISSION RATE 2. RESPIRATORY DISEASE:THERE ARE HIGHER MORTALITY RATES FOR INFLUENZA AND PNEUMONIA IN THE SERVICE AREA THAN THE OVERALL STATE INCIDENCE. THE REGION LACKS A PULMONOLOGIST EVEN THOUGH THE POPULATION IS SUFFICIENT TO SUPPORT THIS SPECIALTY. AS A RESULT, PLHS TOOK THE FOLLOWING ACTIONS: - PULMONOLOGIST RECRUITED AND STARTED FULL TIME PRACTICE JULY 2013. - STARTED A PULMONARY REHABILITATION PROGRAM - NEW PULMONARY FUNCTION MACHINE WITH ADDITIONAL FUNCTIONALITY - ESTABLISHED RURAL OUTREACH - MAINTAINED PULMONOLOGY SERVICES AND CLINIC AFTER DEATH OF PROVIDER AT A CONSIDERABLE EXPENSE - HOME TRANSITION PROGRAM: 1 COMPLIMENTARY HOME HEALTH VISIT, 4 PHONE CALLS, ASSESS PATIENT SURROUNDINGS, ENSURE UNDERSTANDING OF DISCHARGE INSTRUCTIONS AND SELF-CARE, REVIEW MED LIST AND MED SETUP, PROVIDE EDUCATION ON DISEASE OR CONDITION3. DIABETES:THE PRIMARY AND SECONDARY SERVICES AREAS HAD HIGHER RATES OF DIABETES THAN THE NATIONAL AVERAGE. THE PRIMARY SERVICE AREA HAS A HIGHER DIABETES MORTALITY RATE THAN THE SECONDARY SERVICE AREA AND THE STATE. TO ASSIST WITH THIS PROBLEM, PLHS STARTED THE FOLLOWING: - NOVEMBER 2014 STARTED MONTHLY DIABETES SUPPORT GROUP WITH CERTIFIED DIABETIC EDUCATOR - MEETINGS HELD AT PLHS AND VARIOUS SPEAKERS AND OUTSIDE EDUCATION ARE BROUGHT IN - PLHS PAYS SPEAKER STIPEND AND FOR TIME OF THE CDETHE FOLLOWING ARE NEEDS IDENTIFIED IN THE CHNA, BUT NOT ADDRESSED BY PLHS: THE OBESITY ISSUE IS CURRENTLY BEING ADDRESSED THROUGH COMMUNITY NUTRITION, PHYSICAL ACTIVITY, AND WEIGHT LOSS INITIATIVES. PRIMARY CARE CLINICS, THE HOSPITAL, AND THE COMMUNITY RECREATION CENTER PROVIDE A NUMBER OF PROGRAMS. THE HOSPITAL WILL EVALUATE OPPORTUNITIES TO PROVIDE CASH DONATIONS TO SUPPORT COMMUNITY INITIATIVES THAT ADDRESS INEQUITIES ASSOCIATED WITH PROVIDING SERVICES. COMMUNITY-BASED MENTAL HEALTH SERVICES ARE PROVIDED BY THE HUMAN SERVICE AGENCY. THE AGENCY PROVIDES SERVICES TO INDIVIDUALS WITH DEVELOPMENTAL DISABILITIES; THOSE STRUGGLING WITH CHEMICAL AND GAMBLING ADDICTIONS; PEOPLE DIAGNOSED WITH A MENTAL ILLNESS; AND TO INDIVIDUALS COPING WITH A DEPRESSED MOOD, ANXIETY, MARITAL STRESS, OR OTHER LIFE STRESSES. THE AGENCY PROVIDES RESIDENTIAL DETOX SERVICES FOR MEDICALLY STABLE INDIVIDUALS WITH FINANCIAL SUPPORT FOR THIS SERVICE FROM VARIOUS ENTITIES INCLUDING PRAIRIE LAKES HEALTHCARE SYSTEM. PATIENTS REQUIRING INPATIENT MENTAL HEALTH SERVICES ARE TRANSFERRED TO PROVIDERS OUTSIDE THE SERVICE AREA. THE HOSPITAL LACKS THE EXPERTISE TO PROVIDE ADDITIONAL MENTAL HEALTH SERVICES AND DOES NOT WANT TO DUPLICATE THE EFFORTS OF OTHER COMMUNITY PROVIDERS. HOWEVER, THE HOSPITAL WILL SUPPORT EFFORTS TO WORK WITH COMMUNITY MENTAL HEALTH PROVIDERS TO IMPROVE CARE COORDINATION AND REFERRAL PROCESSES. IN ADDITION TO THE TOP FIVE HEALTH CONCERNS, FOUR OTHER CONCERNS WERE IDENTIFIED FROM THE COMMUNITY HEALTH NEEDS ASSESSMENT FY 2013 AND WILL NOT BE TARGETED FOR SPECIFIC INITIATIVES IN THE IMPLEMENTATION PLAN FOR THE REASONS DESCRIBED:1. CANCER2. POOR NUTRITION3. TOBACCO USE4. EXCESSIVE ALCOHOL CONSUMPTIONTHE COMMUNITY HEALTH NEEDS ASSESSMENT REVEALED A LOWER CANCER MORTALITY RATE IN THE SERVICE AREA THAN IN THE STATE. THE ORGANIZATION HAS A FULLY DEVELOPED CANCER PROGRAM. CASH DONATIONS ARE MADE ANNUALLY TO COMMUNITY GROUPS WHO PROVIDE ASSISTANCE TO CANCER PATIENTS WITH NEEDS. NO SPECIFIC INITIATIVES ARE PLANNED BUT THE ORGANIZATION WILL CONTINUE TO PROVIDE CASH DONATIONS TO COMMUNITY GROUPS PROVIDING SUPPORT OF CANCER PATIENTS. THE LIFESTYLE HEALTH ISSUES RELATED TO POOR NUTRITION, TOBACCO USE, AND EXCESSIVE ALCOHOL CONSUMPTION ARE ADDRESSED THROUGH A NUMBER OF COMMUNITY INITIATIVES. PLHS WILL CONTINUE TO SUPPORT THESE INITIATIVES THROUGH CASH DONATIONS. 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. PART V, SECTION B, LINE 16 FINANCIAL ASSISTANCE POLICY WEBSITE AVAILABILITY PRAIRIE LAKES HEALTH CARE SYSTEM PART V, SECTION B, LINE 16A WEBSITE: HTTP://WWW.PRAIRIELAKES.COM/IMAGES/PDFS/PLHS_FINANCIAL_ASSISTANCE_POLICY.PD PRAIRIE LAKES HEALTH CARE SYSTEM PART V, SECTION B, LINE 16B WEBSITE: HTTP://WWW.PRAIRIELAKES.COM/IMAGES/PDFS/FINANCIAL_ASSISTANCE_APPLICATION.PD PRAIRIE LAKES HEALTH CARE SYSTEM PART V, SECTION B, LINE 16C WEBSITE: HTTP://WWW.PRAIRIELAKES.COM/PATIENT-VISITOR-SERVICES/FINANCIAL-ASSISTANCE-P 4 SISSETON SATELLITE DIALYSIS 5 EAST CHESTNUT SISSETON SD 57262 DIALYSIS UNIT MALLARD POINTE SURGICAL CENTER 1425 MICKELSON DRIVE WATERTOWN SD 57201 OUTPATIENT SURGERY CENTER ORTONVILLE SATELLITE DIALYSIS 450 EASTVOLD AVENUE ORTONVILLE MN 56278 DIALYSIS UNIT 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 FROM WORKSHEET 2 OF THE SCHEDULE H INSTRUCTIONS. 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): $2,464,541 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 SHORTAGE CALCULATED IN PART III, LINE 8.THE MEDICARE ALLOWABLE COSTS INCLUDED IN PART III, LINE 6 WAS DERIVED USING THE 2015 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 WATERTOWN UNITED WAY PO BOX 283 WATERTOWN SD 57201 460359557 501(C)(3) 31000 COMMUNITY ORGANIZATION FUNDING NATIONAL KIDNEY FOUNDATION 1970 OAKCREST AVE STE 208 ST PAUL MN 55113 131673104 501(C)(3) 10000 RESEARCH AND SCREENINGS SANFORD CLINIC 901 4TH ST NW WATERTOWN SD 57201 460447693 501(C)(3) 10000 FAMILY PLANNING CLINIC 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) 49000 COMMUNITY DEVELOPMENT LUTHERAN OUTDOORS IN SD 2001 S SUMMIT AVE SIOUX FALLS SD 57197 460320561 501(C)(3) 6000 CAMP SPONSORSHIP 5 1 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 X 0 0 0 0 0 0 0 0 0 JILL FULLER CEO 377820 0 192680 0 0 0 22043 0 22951 0 615494 0 0 0 ADAM PAUL CFO 225565 0 50000 0 0 0 15442 0 16267 0 307274 0 0 0 MICHAEL ANDERSON CHIEF INVESTMENT OFFICER 278375 0 100000 0 0 0 18603 0 21733 0 418711 0 0 0 NATE LAKE VICE PRESIDENT 153946 0 45000 0 2817 0 10732 0 21733 0 234228 0 0 0 TRACI RABINE VICE PRESIDENT 142575 0 45000 0 5915 0 10482 0 21732 0 225704 0 0 0 MICHELE TURBAK CHIEF NURSING OFFICER 158419 0 45000 0 0 0 10969 0 21733 0 236121 0 0 0 CHRIS ADDUCCI MD PHYSICIAN 650000 0 0 0 0 0 7800 0 22933 0 680733 0 0 0 BIPINKUMAR AMIN MD PHYSICIAN 610000 0 0 0 0 0 7800 0 17467 0 635267 0 0 0 EVELIO GARCIA MD PHYSICIAN 1175008 0 0 0 0 0 7800 0 22933 0 1205741 0 0 0 SALEM MAALIKI MD PHYSICIAN 1002753 0 0 0 0 0 7800 0 22933 0 1033486 0 0 0 JENNIFER JONES PHYSICIAN 642500 0 0 0 0 0 7800 0 9819 0 660119 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 9396266 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 A, LINE 4 ARTICLE VII OF PLHS' ARTICLES OF INCORPORATION WAS AMENDED TO REFLECT A CHANGE IN THE DISTRIBUTION OF NET ASSETS UPON DISSOLUTION OF THE ORGANIZATION. THE AMENDMENT GIVES AUTHORITY TO THE BOARD OF DIRECTORS IN DETERMINING WHICH QUALIFIED ORGANIZATION SHALL RECEIVE THE DISTRIBUTION OF THE REMAINING NET ASSETS OF PLHS. THE TERM "QUALIFIED ORGANIZATION" MEANS A CORPORATION OR OTHER ENTITY SELECTED BY THE AFFIRMATIVE VOTE OF A MAJORITY OF THE BOARD OF DIRECTORS THEN IN OFFICE, PROVIDED THAT SUCH CORPORATION OR OTHER ENTITY IS THEN QUALIFIED AS AN EXEMPT ORGANIZATION DESCRIBED IN SECTION 501(C)(3) OR OTHER PROVISIONS OF THE INTERNAL REVENUE CODE, AS AMENDED, OR CORRESPONDING SECTIONS OF ANY FUTURE TAX CODE AND IS A WATERTOWN COMMUNITY-BASED ORGANIZATION THE MEMBERS AND/OR DIRECTORS OF WHICH ARE IN GENERAL FROM WATERTOWN AND THE SURROUNDING REGION, AND WHICH HAS THE AUTHORITY TO SUPPORT OR PROVIDE FOR THE DELIVERY OF HEALTH CARE SERVICES IN THE WATERTOWN COMMUNITY AND THE SURROUNDING REGION. 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 15 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. THIS PROCESS OCCURS ANNUALLY AND WAS LAST PERFORMED IN 2015. THE BOARD APPROVES THE 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. THE EXECUTIVE COMMITTEE REVIEWS AND APPROVES THE SALARIES OF OTHER KEY EMPLOYEES. 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 131,009. PRAIRIE LAKES HOME CONNECTIONS INC 401 9TH AVE NW WATERTOWN SD 57201 460394984 HOMEMAKER & NURSING SERVICES SD 501(C)(3) 9 PRAIRIE LAKES HEALTH CARE SYSTEM INC 0 0 0 0 0 0 0 0 0 0 1 0 1 1 1 1 0 1 0 0