2014-03-10T10:28:23-05:00 2013-05-31 410746749 CLIFTONLARSONALLEN LLP 220 SOUTH SIXTH STREET SUITE 300 MINNEAPOLIS MN 55402 990 2012-06-01 460391067 PRAIRIE LAKES HEALTH CARE SYSTEM INC PRAI 6058827000 PO BOX 1210 WATERTOWN SD 57201 ADAM PAUL 6058827000 2014-02-18 1 ROBERT E SCHILE P00369682 6123764500 2012 2015-11-30 17:44:51Z JILL FULLER PO BOX 1210 WATERTOWN SD 57201 103527713 0 X WWW.PRAIRIELAKES.COM X 1986 SD HEALTH CARE SERVICES 13 9 568 200 971412 0 226880 221819 78930177 76847038 4029479 7926738 2094818 1280572 85281354 86276167 155832 150067 0 0 33433689 34654662 0 0 0 36004779 35071365 69594300 69876094 15687054 16400073 181017131 211469945 32586154 30712094 148430977 180757851 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 60914066 150067 76847038 PRAIRIE LAKES HEALTHCARE SYSTEM (PLHS) IS A LEADER IN REGIONAL HEALTHCARE FOR NORTHEASTERN SOUTH DAKOTA. CARING FOR A NINE-COUNTY SERVICE AREA OF 88,000 PEOPLE, THE HEALTH PROFESSIONALS OF PLHS ARE DEDICATED TO EXCELLENCE. THAT COMMITMENT HAS MADE PLHS ONE OF THE MOST INNOVATIVE RURAL MEDICAL CENTERS IN THE NATION. PLHS HAS BEEN A DYNAMIC MODEL FOR RURAL HEALTH; HAS SERVED AS A "SHOW SITE" FOR PATIENT CARE TECHNOLOGY AND DIAGNOSTIC EQUIPMENT; AND WE ARE UNCHALLENGED IN OUR UNCOMPROMISING CARE FOR PATIENTS AND THEIR FAMILIES. PLHS IS A TECHNOLOGICALLY-ADVANCED PROVIDER OF HEALTHCARE SERVICES TO THE PEOPLE OF NORTHEAST SOUTH DAKOTA. OUR MISSION TO OFFER QUALITY AND COMPASSIONATE SERVICES GUIDES OUR MEDICAL STAFF, EMPLOYEES, ADMINISTRATION, AND BOARD OF DIRECTORS. BECAUSE OF OUR PROACTIVE EFFORTS, PLHS HAS BEEN FIRST IN THE STATE TO OFFER PATIENTS LEADING-EDGE TECHNOLOGY AND SERVICES.PLHS WAS THE FIRST HOSPITAL IN SOUTH DAKOTA TO INSTALL AN ADVANCED COMPUTED TOMOGRAPHY (CT) SCANNER THAT PROVIDES DETAILED IMAGES OF THE BODY. THIS ADVANCED TECHNOLOGY NOT ONLY MEANS MORE DIAGNOSTIC INFORMATION FOR DOCTORS IN ROUTINE SITUATIONS, BUT ITS SPEED CAN ALSO SAVE PRECIOUS EXAM TIME IN THE EMERGENCY ROOM.PLHS FIRST IN STATE TO OFFER IMRT. PRAIRIE LAKES CANCER CENTER WAS THE FIRST CANCER CENTER IN SOUTH DAKOTA TO OFFER ITS PATIENTS A SOPHISTICATED RADIATION THERAPY CALLED IMRT - INTENSITY MODULATED RADIATION THERAPY. THE GOAL AT THE CANCER CENTER IS TO CONTINUE TO STAY ABREAST OF THE LATEST ONCOLOGY TREATMENTS AND TECHNOLOGY AND BRING ADVANCED THERAPIES - LIKE IMRT - HERE TO WATERTOWN.PLHS RECEIVED THE AMERICAN COLLEGE OF CARDIOLOGY FOUNDATION'S NCDR ACTION REGISTRYGWTG PLATINUM PERFORMANCE ACHIEVEMENT AWARD FOR 2013 - ONE OF ONLY 197 HOSPITALS NATIONWIDE TO DO SO. THE AWARD RECOGNIZES PRAIRIE LAKES' COMMITMENT AND SUCCESS IN IMPLEMENTING A HIGHER STANDARD OF CARE FOR HEART ATTACK PATIENTS, AND SIGNIFIES THAT PLHS HAS REACHED AN AGGRESSIVE GOAL OF TREATING THESE PATIENTS TO STANDARD LEVELS OF CARE AS OUTLINED BY THE AMERICAN COLLEGE OF CARDIOLOGY/AMERICAN HEART ASSOCIATION (ACC/AHA) CLINICAL GUIDELINES AND RECOMMENDATIONS.PLHS WAS RECOGNIZED AS A TOP-RANKED HOSPITAL IN THE COUNTRY FOR THE VALUE IT PROVIDES TO THE COMMUNITY BY A LEADING HEALTHCARE FIRM SPECIALIZING IN OPERATIONAL BENCHMARKING AND PERFORMANCE ENHANCEMENT STRATEGIES. PRAIRIE LAKES RECEIVED THE COMMUNITY FIVE STAR DESIGNATION BASED ON ITS PERFORMANCE IN THE FOLLOWING AREAS: FINANCIAL VIABILITY AND PLANT REINVESTMENT, HOSPITAL COST STRUCTURE, HOSPITAL CHARGE STRUCTURE AND HOSPITAL QUALITY PERFORMANCE.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. 60914066 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 1 0 0 0 1 0 0 0 0 0 1 0 0 0 1 79 0 568 1 1 1 0 0 0 0 0 0 0 0 0 X 13 9 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 JOHN CALVIN 1.00 X 0 0 0 ROGER CARTER MD 1.00 X 0 0 0 DUSTIN FLATTEN 1.00 X X 0 0 0 VINCE FOLEY 1.00 X 0 0 0 CATHERINE GERRISH MD 1.00 X 0 0 0 BERNIE HANSON MD 1.00 X 0 0 0 GEOFF HEIG 1.00 X X 0 0 0 MONTE HOPPER 1.00 X X 0 0 0 JIM REDLINGER 1.00 X 0 0 0 GERALD RIEBER MD 1.00 X 0 0 0 MARK ROBY 1.00 X X 0 0 0 DOUGLAS SHARP 1.00 1.00 X 0 0 0 LUANN STRAIT 1.00 2.00 X 0 0 0 JILL FULLER 40.00 2.00 X 470175 0 28364 ADAM PAUL 40.00 X 248532 0 13473 MICHAEL ANDERSON 40.00 X 350920 0 28247 NATE LAKE 40.00 X 167598 0 23603 TRACI RABINE 40.00 X 154998 0 23469 MICHELE TURBAK 40.00 X 166291 0 23730 EVELIO GARCIA MD 40.00 X 1170058 0 28364 SALEM MAALIKI MD 40.00 X 1001488 0 28364 BIPINKUMAR AMIN MD 40.00 X 628462 0 28364 CHRIS ADDUCCI MD 40.00 X 525000 0 28364 JEFFERY BRINDLE MD 40.00 X 503734 0 28364 5387256 0 282706 27 0 1 0 BROWN CLINIC 506 1ST AVE SE WATERTOWN SD 57201 HOSPITALIST/SURGICAL COVERAGE 617695 WEATHERBY LOCUMS PO BOX 972633 DALLAS TX 75397 ER MD ONCOLOGY COVERAGE 382470 DR EW FILLER MD PC 21804 468TH AVE VOLGA SD 57006 ER MD COVERAGE 381963 DR TRUONG THINH 754 TERRA BELLA DRIVE MILPITAS CA 95035 ER MD COVERAGE 334630 PDS INC 4152 30TH AVE S STE 103 FARGO ND 58104 SLEEP STUDIES 266800 11 64180 157639 221819 NET PATIENT SERVICE REVENUE 621400 75876265 75876265 RETAIL PHARMACY 446110 710993 710993 LAB SERVICE 621500 259780 259780 76847038 421015 421015 818795 0 818795 818795 818795 24114131 643138 16580144 671402 7533987 -28264 7505723 7505723 CAFETERIA REVENUE 722210 250985 250985 OTHER INCOME 900099 180059 180059 CATERING 722320 26495 639 25856 4238 4238 461777 86276167 75876265 971412 9206671 150067 150067 1579310 1579310 28399163 25616636 2782527 648446 612988 35458 1979269 1882419 96850 2048474 1784814 263660 26390 26390 6070710 5006106 1064604 244578 16 244562 5783697 5320277 463420 439594 63502 376092 992825 17293 975532 390827 283206 107621 211486 63985 147501 753686 753686 4613384 4379140 234244 323895 323895 DRUGS 6515821 6515821 MEDICAL SUPPLIES 3791679 3791679 PROVISION FOR BAD DEBT 2095388 2095388 EQUIP RENT/MAINTENANCE 1824865 1780214 44651 992540 472934 519606 69876094 60914066 8962028 0 1558 1558 7700535 7906505 7466057 7529123 21033 15522 1767814 672473 1633591 1542896 434407 516464 107101004 55643207 54039109 51457797 101188116 133328865 4688636 5938750 565861 511901 1510414 2048091 181017131 211469945 12148605 11691323 18469057 16468220 1968492 2552551 32586154 30712094 X 145492341 177279679 2938636 3478172 148430977 180757851 181017131 211469945 X 16400073 18353562 -2966297 539536 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 2341520 2341520 47326716 17871195 29455521 2622265 1517951 1104314 54562730 36254061 18308669 247773 247773 51457797 457(B) PAYABLE 1950416 LONG-TERM PTO 510235 ASBESTOS PAYABLE 91900 2552551 X DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: 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 2010 TO 2012 ARE OPEN TO EXAMINATION BY FEDERAL, LOCAL, AND STATE AUTHORITIES. 1 1 X 1 X 1 X 1 1 1 0 1 1 1762970 1762970 0.02520 3121929 1018798 2103131 0.03010 4884899 1018798 3866101 0.05530 8913739 4437469 4476270 0.06410 150067 150067 0.00210 9063806 4437469 4626337 0.06620 13948705 5456267 8492438 0.12150 1 2095388 0 28040933 23739721 4301212 X 1 1 1 1 PRAIRIE LAKES HOSPITAL

401 9TH AVE NW WATERTOWN SD 57201

X X X PRAIRIE LAKES HEALTH CARE SYSTEM 1 1 X X X X X X X X X 12 1 0 1 X 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 3 SISSETON SATELLITE DIALYSIS

5 EAST CHESTNUT SISSETON SD 57262

DIALYSIS UNIT BROOKINGS SATELLITE DIALYSIS

300 22ND AVENUE BROOKINGS SD 57006

DIALYSIS UNIT ORTONVILLE SATELLITE DIALYSIS

450 EASTVOLD AVENUE ORTONVILLE MN 56278

DIALYSIS UNIT 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. $2,095,388 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 4: 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.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.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 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 2013 FILED MEDICARE COST REPORT. PART III, LINE 9B: FINANCIAL ASSISTANCE/CHARITY CARE FORM IS SENT TO THE PATIENT FOR COMPLETION. UPON RECEIPT BY THE FACILITY, THE FORM AND GUIDELINES ARE REVIEWED AND THE PATIENT IS NOTIFIED OF THE QUALIFICATION FOR FINANCIAL ASSISTANCE/CHARITY CARE. THE PATIENT'S ACCOUNT(S) ARE THEN WRITTEN OFF. 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 5C: THE COMMUNITY HEALTH NEEDS ASSESSMENT CAN BE FOUND ON THE ORGANIZATIONS WEBSITE, WWW.PRAIRIELAKES.COM/ABOUT-PLHS/COMMUNITY-BENEFIT.HTML. 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. 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) 30500 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 COMMUNITY FOUNDATION 211 KEMP AVE E WATERTOWN SD 57201 460350319 501(C)(3) 10400 H20 2020/SEA OF GOODWILL FUND 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 JOY RANCH FUNDING CITY OF WATERTOWN 23 2ND ST NE WATERTOWN SD 57201 466000515 CITY GOVERNMENT 10000 FIRE RESCUE TRAINING CENTER 7 1 PROCEDURE FOR MONITORING GRANTS IN THE U.S.: PART I, LINE 2: SCHEDULE I, PART I, LINE 2: THE GRANTS ARE APPROVED BY ADMINISTRATION AND GIVEN AS UNRESTRICTED DONATIONS. THYE ARE NOT MONITORED ONCE GIVEN. X X X 0 0 0 0 0 0 0 0 0 JILL FULLER 277631 0 126000 0 66544 0 7500 0 20864 0 498539 0 0 0 ADAM PAUL 186471 0 40000 0 22061 0 5594 0 7879 0 262005 0 0 0 MICHAEL ANDERSON 214556 0 100000 0 36364 0 7383 0 20864 0 379167 0 0 0 NATE LAKE 116692 0 25000 0 25906 0 4158 0 19445 0 191201 0 0 0 TRACI RABINE 112228 0 23000 0 19770 0 4024 0 19445 0 178467 0 0 0 MICHELE TURBAK 119932 0 23000 0 23359 0 4229 0 19501 0 190021 0 0 0 EVELIO GARCIA MD 892699 0 70000 0 207359 0 7500 0 20864 0 1198422 0 0 0 SALEM MAALIKI MD 975488 0 26000 0 0 0 7500 0 20864 0 1029852 0 0 0 BIPINKUMAR AMIN MD 478500 0 60000 0 89962 0 7500 0 20864 0 656826 0 0 0 CHRIS ADDUCCI MD 454327 0 0 0 70673 0 7500 0 20864 0 553364 0 0 0 JEFFERY BRINDLE MD 441822 0 0 0 61912 0 7500 0 20864 0 532098 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 5204592 25166290 3303 24731480 431508 2010 1 1 1 1 A 0 0 0 0 0 0 1 A 0 0 0 1 0 0 0 0 1 A 1 SCHEDULE K PART IV, ARBITRAGE, LINE 2C 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. SCHEDULE K, PART III SPECIAL RULE FOR REFUNDING OF PRE-2003 ISSUES PLHS IS NOT REQUIRED TO COMPLETE PART III OF SCHEDULE K BECAUSE THE BOND ISSUANCE LISTED IN PART I WERE TO REFUND BONDS ISSUED PRIOR TO JANUARY 1, 2003. THE TAX SOFTWARE USED TO PREPARE THE FORM 990 DOESN'T ALLLOW FOR THE SUPPRESSING OF THIS SECTION, THEREFORE, THESE ANSWERS ARE ANSWERED NO INSTEAD OF BEING LEFT BLANK. SALEM MAALIKI MD HIGHEST COMPENSATED EMPLOYEE SIGNING BONUS X 75000 15522 0 1 1 15522 WATERTOWN PUBLIC OPINION TRUSTEE OF PLHS, MARK ROBY, WAS A KEY EMPLOYEE OF WATERTOWN PUBLIC OPINION 115269 PLHS PAID TO ADVERTISE IN THE WATERTOWN PUBLIC OPINION. 0 BROWN CLINIC TRUSTEE OF PLHS, CATHY GERRISH, WAS A KEY EMPLOYEE OF BROWN CLINIC 625586 PLHS PAID BROWN CLINIC FOR: CONTRACT HOSPITALIST PHYSICIANS, MEDICAL DIRECTORSHIP, TRAUMA CALL COVERAGE, AND COMPENSATION FOR COMPUTER TRAINING. 0 SANFORD CLINIC WATERTOWN TRUSTEE OF PLHS, ROGER CARTER, WAS A KEY EMPLOYEE OF SANFORD CLINIC 721066 SANFORD PAID PLHS FOR RENT AND UTILITIES FOR A MEDICAL OFFICE BUILDING ON THE HOSPITAL'S MAIN CAMPUS. 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 WILL REVIEW THE FORM 990 IN DETAIL. THEY WILL THEN PRESENT 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 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. 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. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 9: CHANGE IN BENEFICIAL INTEREST IN PRAIRIE LAKES FOUNDATION 539,536. PRAIRIE LAKES HOME CONNECTIONS INC 401 9TH AVE NW WATERTOWN SD 57201 460394984 HOMEMAKER & NURSING SERVICES SD 501(C)(3) 9 N/A 0 PRAIRIE LAKES FOUNDATION INC 401 9TH AVE NW WATERTOWN SD 57201 460350240 PROMOTES HEALTH EDUCATION AND GENERAL HEALTH AND WELL-BEING OF THE PUBLIC SD 501(C)(3) 7 N/A 0 0 0 1 0 0 0 0 0 0 1 0 1 1 1 1 0 1 0 0