2015-04-09T12:31:37-05:00 2014-05-31 410746749 CLIFTONLARSONALLEN LLP 220 SOUTH SIXTH STREET SUITE 300 MINNEAPOLIS MN 55402 990 2013-06-01 460391067 PRAIRIE LAKES HEALTH CARE SYSTEM INC PRAI 6058827000 PO BOX 1210 WATERTOWN SD 57201 ADAM PAUL CFO 6058827000 2015-04-03 1 ROBERT E SCHILE P00369682 6123764500 2013 2016-02-25 16:41:14Z JILL FULLER PO BOX 1210 WATERTOWN SD 57201 113398744 0 X WWW.PRAIRIELAKES.COM X 1986 SD HEALTH CARE SERVICES 15 13 620 186 807933 0 221819 55328 76847038 79389439 7926738 9496857 1280572 2775855 86276167 91717479 150067 155483 0 0 34654662 38855388 0 0 0 35071365 36984502 69876094 75995373 16400073 15722106 211469945 234746435 30712094 29373739 180757851 205372696 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 66521665 155483 78477169 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 SPECIALTY PHYSICIANS IN ORDER TO BUILD NEW SERVICES THAT WERE NEEDED IN THE REGION. IN THE PAST YEAR, 6 NEW PHYSICIANS WERE RECRUITED INCLUDING A UROLOGIST, AN ENT SURGEON AND A PULMONOLOGIST. THIS IS THE FIRST TIME FULL-TIME PULMONOLOGY SERVICES HAVE BEEN AVAILABLE IN THE COMMUNITY. PLHS CONTRACTED WITH A NEW PRIVATE PRACTICE RADIOLOGY GROUP OF OVER 70 PHYSICIANS THAT PROVIDE TELERADIOLOGY SERVICES AND WEEKLY ON-SITE PROCEDURAL RADIOLOGY SERVICES. RADIOLOGY SERVICES WERE ENHANCED WITH THIS ADDITION OF FELLOWSHIP-TRAINED SUBSPECIALTY RADIOLOGISTS TRAINED IN BODY, BREAST, NUCLEAR MEDICINE, INTERVENTIONAL, MUSCULOSKELETAL AND NEURORADIOLOGY. PLHS ALSO CONTINUED TO INCREASE THE NUMBER OF RURAL OUTREACH CLINICS FROM 10 TO 14. THESE CLINICS PROVIDE ACCESS TO SPECIALTY PHYSICIANS IN RURAL COMMUNITIES IN THE PLHS SERVICE AREA. WORKING WITH OTHER PHYSICIANS IN THE COMMUNITY, PLHS INITIATED A CLINICAL INTEGRATION COLLABORATIVE. THE COLLABORATIVE WILL SELECT AREAS FOR FOCUSED IMPROVEMENT SUCH AS CARE COORDINATION, REFERRAL COORDINATION, CHRONIC CARE MANAGEMENT AND ACCESS EXPANSION. THE ORGANIZATION'S COMMITMENT TO IMPROVING QUALITY AND PATIENT OUTCOMES WAS ACKNOWLEDGED BY THE RECEIPT OF SEVERAL AWARDS. 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. PLHS ALSO RECEIVED THE 2014 WOMEN'S CHOICE AWARD AS ONE OF AMERICA'S BEST HOSPITALS FOR EMERGENCY CARE. THE AWARD GRANTED TO ONLY 241 HOSPITALS IN THE NATION, WAS BASED ON PUBLICALLY REPORTED MEASURES OF EMERGENCY CARE DEEMED MOST IMPORTANT TO WOMEN. PLHS RECEIVED NO PENALTIES FOR AVOIDABLE HOSPITAL ADMISSIONS AS PART OF THE FEDERAL GOVERNMENT'S HOSPITAL READMISSION REDUCTION PROGRAM. PLHS RECEIVED A NUMBER OF RECOGNITIONS THAT RECOGNIZED FINANCIAL STABILITY AND PERFORMANCE. CLEVERLEY + ASSOCIATES, A LEADING HEALTHCARE FIRM SPECIALIZING IN OPERATIONAL BENCHMARKING, AWARDED PRAIRIE LAKES THE COMMUNITY FIVE STAR DESIGNATION BASED ON PERFORMANCE IN THE FOLLOWING AREAS: FINANCIAL VIABILITY AND PLANT REINVESTMENT, HOSPITAL COST STRUCTURE, HOSPITAL CHARGE STRUCTURE AND HOSPITAL QUALITY PERFORMANCE.PLHS WAS NAMED A 2014 HEALTHSTRONG HOSPITAL BY IVANTAGE HEALTH ANALYTICS. PRAIRIE LAKES WAS AMONG 547 HOSPITALS NATIONWIDE SELECTED FOR THIS HONOR, RANKING IN THE TOP 13% OF THE 4,299 HOSPITALS STUDIED. THE PURPOSE OF THE HEALTHSTRONG HOSPITAL STUDY WAS TO PROVIDE A COMPREHENSIVE COMPARISON OF ACUTE CARE HOSPITALS ACROSS A CONTINUUM OF QUALITY, POPULATION HEALTH, OUTCOMES AND FINANCIAL INDICATORS. THE 2014 HEALTHSTRONG HOSPITALS HIGHLIGHTS TOP PERFORMING HOSPITALS RATED AS PART OF IVANTAGE'S HOSPITAL STRENGTH INDEX. THE HOSPITAL STRENGTH INDEX IS A COMPREHENSIVE RATING SYSTEM OF HOSPITALS AND THE RESULTS RECOGNIZE THE TOP PERFORMING HOSPITALS-MEASURING THEM ACROSS 66 DIFFERENT PERFORMANCE METRICS, INCLUDING QUALITY, VALUE-BASED OUTCOMES, PATIENT PERSPECTIVE, AFFORDABILITY, FINANCIALS AND EFFICIENCY. IN MAY 2013, CMS RELEASED HOSPITAL PRICE RANGES OF 100 COMMON TREATMENTS. THE REPORT SHOWED WIDE VARIATIONS AMONG HOSPITALS IN PRICES CHARGED FOR THE SAME PROCEDURES. PLHS CONSISTENTLY HAD THE LOWEST PRICES AMONG THE STATE PROVIDERS FOR PROCEDURES PERFORMED AT THE HOSPITAL. FOR THE PAST DECADE, THE ORGANIZATION HAS MADE A CONCERTED EFFORT TO BENCHMARK FAVORABLY TO OTHER PROVIDERS ON PRICING. 66521665 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 1 0 0 0 0 0 1 0 0 0 1 84 0 620 1 1 1 0 0 0 0 0 0 0 0 0 X 15 13 0 0 0 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 0.00 X X 0 0 0 GEOFF HEIG BOARD VICE CHAIR 1.00 0.00 X X 0 0 0 JIM REDLINGER BOARD SECRETARY 1.00 0.00 X X 0 0 0 DUSTIN FLATTEN BOARD TREASURER 1.00 1.00 X X 0 0 0 MONTE HOPPER PAST BOARD CHAIR 1.00 0.00 X 0 0 0 JOHN CALVIN BOARD MEMBER 1.00 0.00 X 0 0 0 ROGER CARTER MD BOARD MEMBER 1.00 0.00 X 0 0 0 VINCE FOLEY BOARD MEMBER 1.00 0.00 X 0 0 0 CATHERINE GERRISH MD BOARD MEMBER 1.00 0.00 X 0 0 0 BERNIE HANSON MD BOARD MEMBER 1.00 0.00 X 0 0 0 TOM LABRIE BOARD MEMBER 1.00 0.00 X 0 0 0 ROBB PETERSON BOARD MEMBER 1.00 0.00 X 0 0 0 GERALD RIEBER MD BOARD MEMBER 1.00 0.00 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 528354 0 19193 ADAM PAUL CFO 40.00 0.00 X 256886 0 6819 MICHAEL ANDERSON CHIEF INVESTMENT OFFICER 40.00 0.00 X 365246 0 19193 NATE LAKE VICE PRESIDENT 40.00 0.00 X 178778 0 19193 TRACI RABINE VICE PRESIDENT 40.00 0.00 X 174258 0 19193 MICHELE TURBAK CHIEF NURSING OFFICER 40.00 0.00 X 178484 0 19193 CHRIS ADDUCCI MD PHYSICIAN 40.00 0.00 X 655769 0 19193 BIPINKUMAR AMIN MD PHYSICIAN 40.00 0.00 X 610000 0 19193 JEFFERY BRINDLE MD PHYSICIAN 40.00 0.00 X 502008 0 19193 EVELIO GARCIA MD PHYSICIAN 40.00 0.00 X 1251162 0 19193 SALEM MAALIKI MD PHYSICIAN 40.00 0.00 X 1057978 0 19193 5758923 0 198749 33 0 1 0 BROWN CLINIC 506 1ST AVE SE WATERTOWN SD 57201 HOSPITALIST/SURGICAL COVERAGE 732009 WEATHERBY LOCUMS PO BOX 972633 DALLAS TX 75397 ER/MD/ONCOLOGY COVERAGE 475787 DR EW FILLER MD PC 21804 468TH AVE VOLGA SD 57006 ER/MD COVERAGE 372632 PDS INC 4152 30TH AVE S STE 103 FARGO ND 58104 SLEEP STUDIES 255200 DR RAM PANKAJ 3 CASCADE COURT EAST BURR RIDGE IL 60521 ORTHO LOCUM COVERAGE 204137 13 55328 55328 NET PATIENT SERVICE REVENUE 621400 78581886 78581886 RETAIL PHARMACY 446110 700483 700483 LAB SERVICE 621500 107070 107070 79389439 389982 389982 897673 0 897673 897673 897673 29379212 1408928 20269738 1411527 9109474 -2599 9106875 9106875 EHR INCENTIVE PAYMENT 900099 1320911 1320911 OTHER INCOME 900099 270556 270556 CAFETERIA REVENUE 722210 256796 256796 29919 380 29539 1878182 91717479 78581886 807933 12272332 155483 155483 1980137 1980137 31245019 28275096 2969923 683776 683776 2701373 2490210 211163 2245083 1958774 286309 22308 22308 89702 89702 5899551 5197527 702024 251685 251685 1391907 852454 539453 488989 21849 467140 1255548 321621 933927 402778 285061 117717 222187 84360 137827 693344 693344 4589824 4360952 228872 395026 395026 MEDICAL SUPPLIES 9678915 9678915 DRUGS 6421857 6421857 PROVISION FOR BAD DEBT 2589273 2589273 EQUIP RENT/MAINTENANCE 1562205 1535916 26289 1029403 520171 509232 75995373 66521665 9473708 0 1558 1626 7906505 9402972 7529123 8914210 15522 672473 261301 1542896 1499071 516464 503912 107862227 58823270 51457797 49038957 133328865 153988709 5938750 6243565 511901 466030 2048091 4426082 211469945 234746435 11691323 11923375 16468220 14412383 2552551 3037981 30712094 29373739 X 177279679 201613434 3478172 3759262 180757851 205372696 211469945 234746435 X 15722106 8615248 -3599 281090 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 2341520 2341520 47184782 19161722 28023060 2661249 1571106 1090143 55591369 38090442 17500927 83307 83307 49038957 457(B) PAYABLE 2446333 LONG-TERM PTO 499748 ASBESTOS PAYABLE 91900 3037981 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. THE HEALTH SYSTEM'S INCOME TAX RETURNS ARE SUBJECT TO REVIEW AND EXAMINATION BY FEDERAL, STATE, AND LOCAL AUTHORITIES. THE INFORMATION TAX RETURNS FOR THE YEARS ENDED 2011 TO 2013 ARE OPEN TO EXAMINATION BY FEDERAL, LOCAL, AND STATE AUTHORITIES. 1 1 X 1 X 1 X 1 1 1 0 1 1 1795995 1795995 0.02360 3182846 1252546 1930300 0.02540 4978841 1252546 3726295 0.04900 9430658 4762675 4667983 0.06140 155483 155483 0.00200 9586141 4762675 4823466 0.06340 14564982 6015221 8549761 0.11240 1 2589273 0 28685804 25390336 3295468 X 1 1 1 1 PRAIRIE LAKES HOSPITAL 401 9TH AVE NW WATERTOWN SD 57201 WWW.PRAIRIELAKES.COM 10572 X X X PRAIRIE LAKES HEALTH CARE SYSTEM 1 1 X X X X X X X X X 12 1 0 1 X WWW.PRAIRIELAKES.COM X X X X X X X X X 0 0 1 1 150.000000000000 1 200.000000000000 1 X X X X X X 1 1 X X X X 1 0 X X X 1 X 0 0 PRAIRIE LAKES HEALTH CARE SYSTEM PART V, SECTION B, LINE 3: 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 FOR 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 7: 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 20D: 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 OR PRIVATE INSURANCE. 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: 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 MAY INCLUDE THE FOLLOWING FACTORS:(A) INDIVIDUAL OR FAMILY INCOME AND NET WORTH(B) EMPLOYMENT STATUS AND EARNING CAPACITY(C) FAMILY SIZE(D) OTHER FINANCIAL OBLIGATIONS(E) THE AMOUNT AND FREQUENCY OF BILLINGS FOR HEALTHCARE SERVICES(F) OTHER SOURCES OF PAYMENT FOR THE SERVICES RENDERED(G) TYPE OF SERVICES PROVIDED, WHETHER ELECTIVE OR NON-ELECTIVE PART I, LINE 7: THE COSTS ARE CALCULATED USING A COST TO CHARGE RATIO DERIVED FROM WORKSHEET 2 OF THE SCHEDULE H INSTRUCTIONS. $2,589,273 IN BAD DEBT EXPENSE WAS ELIMINATED WHEN CALCULATING PART I, LINE 7. PART I, LINE 7G: THE SUBSIDIZED HEALTH SERVICES INCLUDED IN SCHEDULE H, PART I, LINE 7G RELATES TO THE EMERGENCY ROOM, CARDIOLOGY SERVICES, ONCOLOGOY SERVICES, AND SPECIALTY PHYSICIANS. PART III, LINE 2: BAD DEBT EXPENSE INCLUDED IN PART III, LINE 2 IS DETERMINED BY THE PERCENTAGE OF PRIVATE PAY ACCOUNTS THAT ARE HISTORICALLY WRITTEN OFF TO BAD DEBT. 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 2014 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 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: PRIVATE PAY INPATIENTS SPEAK WITH A SOCIAL WORKER TO DETERMINE IF THEY HAVE A NEED FOR FINANCIAL ASSISTANCE. THE SOCIAL WORKER WILL GIVE THEM A NUMBER OF AVAILABLE OPTIONS FOR ASSISTANCE. AFTER A PATIENT HAS RECEIVED STATEMENTS WITH THE PORTION THAT THEY ARE RESPONSIBLE FOR THEY ARE CONTACTED TO SEE IF THEY ARE IN NEED OF FINANCIAL ASSISTANCE. AT THAT TIME THEY ARE INFORMED OF ALL OPTIONS AVAILABLE TO THEM. 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 WATERTOWN AREA TRANSIT 205 1ST AVE NE WATERTOWN SD 57201 411908759 501(C)(3) 10000 TRANSIT BUS HUMAN SERVICE AGENCY PO BOX 1030 WATERTOWN SD 57201 460275247 501(C)(3) 6000 DETOX FUNDING FOCUS WATERTOWN 1 EAST KEMP AVE WATERTOWN SD 57201 470813269 501(C)(6) 32000 COMMUNITY DEVELOPMENT LUTHERAN OUTDOORS IN SD 2001 S SUMMIT AVE SIOUX FALLS SD 57197 460320561 501(C)(3) 6000 CAMP SPONSORSHIP CITY OF WATERTOWN 23 2ND ST NE WATERTOWN SD 57201 466000515 CITY GOVERNMENT 10000 FIRE RESCUE TRAINING CENTER 7 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 347308 0 167414 0 13632 0 0 0 19193 0 547547 0 0 0 ADAM PAUL CFO 208544 0 40000 0 8342 0 0 0 6819 0 263705 0 0 0 MICHAEL ANDERSON CHIEF INVESTMENT OFFICER 254948 0 100000 0 10298 0 0 0 19193 0 384439 0 0 0 NATE LAKE VICE PRESIDENT 145080 0 28000 0 5698 0 0 0 19193 0 197971 0 0 0 TRACI RABINE VICE PRESIDENT 134929 0 28000 0 11329 0 0 0 19193 0 193451 0 0 0 MICHELE TURBAK CHIEF NURSING OFFICER 144553 0 28000 0 5931 0 0 0 19193 0 197677 0 0 0 CHRIS ADDUCCI MD PHYSICIAN 630769 0 25000 0 0 0 0 0 19193 0 674962 0 0 0 BIPINKUMAR AMIN MD PHYSICIAN 610000 0 0 0 0 0 0 0 19193 0 629193 0 0 0 JEFFERY BRINDLE MD PHYSICIAN 502008 0 0 0 0 0 0 0 19193 0 521201 0 0 0 EVELIO GARCIA MD PHYSICIAN 1091546 0 130000 0 29616 0 0 0 19193 0 1270355 0 0 0 SALEM MAALIKI MD PHYSICIAN 981421 0 76557 0 0 0 0 0 19193 0 1077171 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 7260429 25166290 3303 24731480 431508 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. WATERTOWN PUBLIC OPINION TRUSTEE OF PLHS, MARK ROBY, WAS A KEY EMPLOYEE OF WATERTOWN PUBLIC OPINION 58499 PLHS PAID TO ADVERTISE IN THE WATERTOWN PUBLIC OPINION. 0 BROWN CLINIC TRUSTEE OF PLHS, CATHY GERRISH, WAS A KEY EMPLOYEE OF BROWN CLINIC 558508 PLHS PAID BROWN CLINIC FOR: CONTRACT HOSPITALIST PHYSICIANS, MEDICAL DIRECTORSHIP, AND TRAUMA CALL COVERAGE. 0 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 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. THE LAST COMPENSATION STUDY WAS PERFORMED IN 2014. 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 281,090. 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