2021-04-14T20:28:57-05:00 2020-05-31 410746749 CLIFTONLARSONALLEN LLP 220 S 6TH STREET SUITE 300 MINNEAPOLIS MN 55402 990 2019-06-01 460391067 PRAIRIE LAKES HEALTH CARE SYSTEM INC PRAI 6058827000 PO BOX 1210 WATERTOWN SD 57201 ADAM POPP CFO 6058827000 2021-04-14 1 ROBERT E SCHILE P00369682 6123764500 2021-04-13 2019 2022-09-23 18:48:47Z KC DEBOER PO BOX 1210 WATERTOWN SD 57201 245843362 0 X WWW.PRAIRIELAKES.COM X 1986 SD PROVIDE HIGH QUALITY, AFFORDABLE & COMPASSIONATE HEALTHCARE SERVICES FOR THE PEOPLE IN THE REGION. 14 13 665 190 1044364 211018 632539 2446978 102566717 98526177 15332407 13490621 1528183 1516078 120059846 115979854 293785 166878 0 0 50433086 52101747 0 0 0 50050505 49914219 100777376 102182844 19282470 13797010 328290825 318634035 54681592 54911822 273609233 263722213 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 88358959 166878 97481813 PRAIRIE LAKES HEALTH CARE SYSTEM SERVES TEN COUNTIES IN NORTHEASTERN SOUTH DAKOTA AND WESTERN MINNESOTA AS A RURAL, REGIONAL MEDICAL CENTER. IT IS COMMITTED TO PROVIDING ACCESSIBLE, HIGH QUALITY, COST-EFFECTIVE HEALTHCARE SERVICES AS IT MANAGES EFFECTIVELY THE TRANSITION TO NEW PAYMENT AND CARE DELIVERY MODELS. TWENTY-FIVE SPECIALTY PHYSICIANS HAVE BEEN RECRUITED OVER THE PAST DECADE TO BUILD NEW SERVICES AND BETTER SERVE THE NEEDS OF THE REGION. A PULMONOLOGIST JOINED THE STAFF IN 2019 AFTER COMPLETING RESIDENCY. 88358959 1 1 0 0 0 0 0 0 0 0 1 0 0 1 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 96 0 665 1 1 1 0 0 0 0 0 0 0 0 0 0 0 X 14 13 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 0 0 X ADAM POPP 6058827000 401 9TH AVENUE NW WATERTOWN SD 57201 SALEM MAALIKI MD PHYSICIAN 40.00 0.00 X 1224451 0 33923 EVELIO GARCIA MD PHYSICIAN 40.00 0.00 X 1291941 0 32884 JEFFREY SMITH MD PHYSICIAN 40.00 0.00 X 787695 0 33923 MIAN JAVAID MD PHYSICIAN 40.00 0.00 X 615138 0 27539 LEIGHTON SINGH MD PHYSICIAN 40.00 0.00 X 588005 0 33923 KC DEBOER CHIEF EXECUTIVE OFFICER 40.00 1.00 X 399220 0 49199 CATHERINE GERRISH MD BOARD MEMBER 1.00 0.00 X 0 0 0 NATE LAKE VICE PRESIDENT 40.00 1.00 X 231367 0 38495 GRANT TILLETT CHIEF INFORMATION OFFICER 40.00 0.00 X 219120 0 40390 D ADAM POPP CHIEF FINANCIAL OFFICER 40.00 1.00 X 220882 0 34795 TRACI RABINE VICE PRESIDENT 40.00 0.00 X 202263 0 39953 MICHELE TURBAK CHIEF NURSING OFFICER 40.00 0.00 X 203493 0 33998 JIM REDLINGER CHAIR 1.00 0.00 X X 0 0 0 ROBB PETERSON VICE CHAIR 1.00 0.00 X X 0 0 0 SHANNON KRUSE SECRETARY 1.00 0.00 X X 0 0 0 VINCE FOLEY TREASURER 1.00 1.00 X X 0 0 0 JOHN CALVIN BOARD MEMBER 1.00 0.00 X 0 0 0 CHRIS CARTER BOARD MEMBER 1.00 0.00 X 0 0 0 ALAN CHRISTENSEN MD BOARD MEMBER 1.00 0.00 X 0 0 0 BERNIE HANSON MD BOARD MEMBER 1.00 0.00 X 0 0 0 STACEY LEE BOARD MEMBER 1.00 0.00 X 0 0 0 MIKE LUKEN BOARD MEMBER 1.00 0.00 X 0 0 0 GERALD RIEBER MD BOARD MEMBER 1.00 0.00 X 0 0 0 MARK ROBY PAST CHAIR 1.00 0.00 X 0 0 0 DOUG SHARP BOARD MEMBER 1.00 0.00 X 0 0 0 5983575 0 399022 43 0 1 0 GHAITH ABOUD MD 920 3RD ST NW APT C WATERTOWN SD 57201 LOCUM PHYSICIAN 571900 COMPHEALTH PO BOX 972651 DALLAS TX 75397 LOCUM COVERAGE 443848 WAPITI MEDICAL GROUP 107 FLYNN DRIVE STE 600 MILBANK SD 57252 LOCUM COVERAGE 299526 DMS HEALTH TECHNOLOGIES PO BOX 670747 DALLAS TX 75267 PET SCAN 290410 CASEY D JOHNSTON MD 3325 SIOUX CONIFER RD WATERTOWN SD 57201 LOCUM PHYSICIAN 203450 15 2392368 54610 2446978 NET PATIENT SERVICE REVENUE 621400 97481813 97481813 RETAIL PHARMACY 446110 887564 887564 LAB SERVICE 621500 156800 156800 98526177 -122706 -122706 1134434 0 1134434 1134434 1134434 143476835 129856362 7146 13620473 -7146 13613327 13613327 CAFETERIA REVENUE 722210 245848 245848 OTHER INCOME 900099 155875 155875 CATERING 722320 3113 3113 -23192 -23192 381644 115979854 97481813 1044364 15006699 166878 166878 1921056 1921056 42686660 38695646 3991014 1014458 970919 43539 3566102 3232459 333643 2913471 2531027 382444 34528 34528 7230921 5730314 1500607 495489 495489 1703112 1216963 486149 766903 70582 696321 909089 24938 884151 309207 401409 -92202 198575 120931 77644 876789 876789 7008495 4687996 2320499 419745 419745 DRUGS 10957780 10957780 MEDICAL SUPPLIES 10577227 10577227 PROVISION FOR BAD DEBT 5061598 5061598 EQUIP RENT/MAINTENANCE 2069590 2059041 10549 1295171 556717 738454 102182844 88358959 13823885 0 1573 1573 7528469 14289538 11761509 8119474 543256 566789 3127153 3361151 919979 1155840 163360936 83307818 84060097 80053118 195398639 185098262 4217679 4137187 2392565 3458036 18339906 18393067 328290825 318634035 13546513 13575123 71097 5218055 34390295 29737808 887945 443973 5785742 5936863 54681592 54911822 X 269695989 259890520 3913244 3831693 273609233 263722213 328290825 318634035 X 13797010 -23575194 -27287 -81549 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 3986297 3986297 85061170 29640243 55420927 2913298 2148634 764664 71267780 51518941 19748839 132391 132391 80053118 DUE FROM 457(B) PLAN 5246086 ACCRUED INTEREST RECEIVABLE 261428 ACCRUED REAL ESTATE 10533290 DUE FROM RELATED PARTY 2352263 18393067 457(B) PAYABLE 5246086 LONG-TERM PTO 598877 ASSET RETIREMENT OBLIGATION 91900 5936863 X PART X, LINE 2: THE INTERNAL REVENUE SERVICE (IRS) HAS DETERMINED THAT PRAIRIE LAKES IS A TAX-EXEMPT, NOT-FOR-PROFIT CORPORATION 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 1886886 1886886 0.01940 4624180 3000093 1624087 0.01670 6511066 3000093 3510973 0.03610 60025 0 60025 0.00060 15110939 8146993 6963946 0.07170 15170964 8146993 7023971 0.07230 21682030 11147086 10534944 0.10840 1 5061598 0 34435853 33049704 1386149 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 18 1 0 0 1 X SEE LINE 7D X 1 18 1 SEE LINE 7D 0 1 X 150.000000000000 200.000000000000 X X X X 1 1 X X X X 1 X SEE LINE 16J X SEE LINE 16J X SEE LINE 16J X X X X X X X 1 X 0 X X 1 X 0 0 PRAIRIE LAKES HEALTH CARE SYSTEM PART V, SECTION B, LINE 5: TO ENSURE INPUT FROM PERSONS WITH BROAD KNOWLEDGE OF THE COMMUNITY, TWO FOCUS GROUP MEETINGS WERE CONDUCTED (NOVEMBER 7TH AND 8TH 2018) WITH INDIVIDUALS IN THE COMMUNITY. INVITATIONS WERE SENT TO INDIVIDUALS REPRESENTING VARIOUS COMMUNITY, BUSINESS, AND EDUCATIONAL ORGANIZATIONS. REPRESENTATIVES FROM LOCAL HEALTH CARE PROVIDERS AND THE COMMUNITY HEALTH DEPARTMENTS WERE INCLUDED TO BRING IN ADDITIONAL PROFESSIONAL PERSPECTIVE. FOR INVITEES UNABLE TO ATTEND THE FOCUS GROUP SESSIONS, INPUT WAS GATHERED VIA EMAIL OR PHONE INTERVIEW. THE INDIVIDUALS IDENTIFIED TO PARTICIPATE IN THE PROCESS HAVE DIRECT ACCESS TO INDIVIDUALS ACROSS ALL SUBSECTIONS OF THE COMMUNITY AND THEREFORE CAN ADDRESS NEEDS THAT MAY IMPACT THOSE POPULATIONS THAT ARE MEDICALLY UNDERSERVED OR MOST IN NEED. SEE PAGE 17 OF THE 2018 COMMUNITY HEALTH NEEDS ASSESSMENT REPORT, WHICH IS AVAILABLE ON OUR WEBSITE, FOR A FULL LIST OF PARTICIPATING ORGANIZATIONS. PRAIRIE LAKES HEALTH CARE SYSTEM PART V, SECTION B, LINE 7D: THE ORGANIZATION'S COMMUNITY HEALTH NEEDS ASSESSMENT REPORT AND IMPLEMENTATION STRATEGY ARE AVAILABLE ONLINE AT HTTPS://WWW.PRAIRIELAKES.COM/COMMUNITY/COMMUNITY-BENEFIT-513.HTML. PRAIRIE LAKES HEALTH CARE SYSTEM PART V, SECTION B, LINE 11: DURING THE FISCAL YEAR ENDED MAY 31, 2020, PRAIRIE LAKES HEALTHCARE SYSTEM TOOK THE FOLLOWING STEPS TO ADDRESS SIGNIFICANT COMMUNITY HEALTH NEEDS AS IDENTIFIED IN ITS MOST RECENT COMMUNITY HEALTH NEEDS ASSESSMENT. 1. ACCESS TO PRIMARY AND SPECIALTY CARE SERVICES- PLHS PROVIDES RECRUITING RESOURCES AND FINANCIAL ASSISTANCE FOR THE RECRUITMENT OF PHYSICIANS TO THE COMMUNITY. PLHS WILL CONTINUE TO EXPLORE THE NEED FOR ADDITIONAL SPECIALTIES AND PURSUE RECRUITMENT AS NECESSARY. TELEHEALTH SERVICES WERE ADDED TO ASSIST IN PROVIDING SPECIALTY CARE AS A RESULT OF COVID-19.- PLHS PAYS WATERTOWN AREA COMMUNITY TRANSIT FOR TRANSPORTATION OF INDIVIDUALS TO AND FROM HEALTH APPOINTMENTS IN WATERTOWN.- PLHS FINANCIALLY SUPPORTED THE INITIATION OF THE HELPLINE IN CODINGTON COUNTY.2. SUBSTANCE ABUSE- THE LIFESTYLE HEALTH ISSUES RELATED TO TOBACCO USE AND EXCESSIVE ALCOHOL CONSUMPTION ARE ADDRESSED THROUGH A NUMBER OF COMMUNITY INITIATIVES. PLHS WILL CONTINUE TO SUPPORT THESE INITIATIVES THROUGH CASH DONATIONS.- PLHS COLLABORATED WITH HUMAN SERVICE AGENCY AND WATERTOWN BOYS AND GIRLS CLUB TO ORGANIZE A COMMUNITY EDUCATION TO PROMOTE THE PREVENTION OF DRUG, OPIOID, ALCOHOL USE, AND SMOKING.3. NURTRITION HEALTH/OBESITY- OBESITY 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. - PLHS PROVIDED CASH DONATIONS TO SUPPORT COMMUNITY INITIATIVES SUCH AS: PEOPLE AGAINST CHILD HUNGER AND BOYS AND GIRLS CLUB.4. PREVENTATIVE CARE- PLHS PROVIDED FREE COMMUNITY EDUCATION, INCLUDING TOPICS ON ACID REFLUX, LUNG CANCER, BREATHING ISSUES, STRETCHING, AND COLON CANCER.- PLHS COMPENSATED A SOCIAL WORKER TO PROVIDE DIABETES EDUCATION VIA FREE WORKSHOPS AND SUPPORT GROUPS.5. HEALTHCARE COSTS- PLHS HAS A FINANCIAL ASSISTANCE POLICY TO PROVIDE CHARITY CARE TO LOW-INCOME AND MEDICALLY UNDERSERVED INDIVIDUALS THAT QUALIFY.6. NEEDS NOT ADDRESSED- DENTAL CARE/ORAL HEATLH, SEXUALLY TRANSMITTED INFECTIONS, TEEN PREGNANCY- THESE NEEDS ARE BEYOND PLHS' SCOPE AND ARE BEING ADDRESSED BY OTHER ORGANIZATIONS. PLHS DOES MAKE CASH CONTRIBUTIONS TO ASSIST THOSE ORGANIZATIONS WITH THEIR EFFORTS. PRAIRIE LAKES HEALTH CARE SYSTEM PART V, SECTION B, LINE 16J: HTTPS://WWW.PRAIRIELAKES.COM/BILLING-AND-INSURANCE/FINANCIAL-ASSISTANCE-PROGRAM-510.HTML 3 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 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 CONSIDERED 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 OF THE SUBSIDIZED SERVICES ARE BASED ON DIRECT COST PROVIDED BY THE DEPARTMENTS FOR THE SERVICES. PART I, LINE 7G: THE SUBSIDIZED HEALTH SERVICES INCLUDED IN SCHEDULE H, PART I, LINE 7G RELATE TO THE EMERGENCY ROOM, CARDIOLOGY CLINIC, ONCOLOGY CLINIC, NEPHROLOGY CLINIC, UROLOGY CLINIC, PULMONOLOGY CLINIC, AND ENT CLINIC. PART I, LN 7 COL(F): $5,061,598 OF BAD DEBT EXPENSE WAS ELIMINATED WHEN CALCULATING PART I, LINE 7, COLUMN F. PART III, LINE 2: IN EVALUATING THE COLLECTABILITY OF PATIENT ACCOUNTS RECEIVABLE, THE HEALTH SYSTEM ANALYZES ITS PAST HISTORY AND IDENTIFIES TRENDS FOR EACH OF ITS MAJOR PAYER SOURCES OF REVENUE TO ESTIMATE THE APPROPRIATE ALLOWANCE FOR DOUBTFUL ACCOUNTS AND PROVISION FOR BAD DEBTS. MANAGEMENT REGULARLY REVIEWS DATA ABOUT THESE MAJOR PAYER SOURCES OF REVENUE IN EVALUATING THE SUFFICIENCY OF THE ALLOWANCE FOR DOUBTFUL ACCOUNTS. FOR RECEIVABLES ASSOCIATED WITH SERVICES PROVIDED TO PATIENTS WHO HAVE THIRD-PARTY COVERAGE, THE HEALTH SYSTEM ANALYZES CONTRACTUALLY DUE AMOUNTS AND PROVIDES AN ALLOWANCE FOR DOUBTFUL ACCOUNTS AND A PROVISION FOR BAD DEBTS, IF NECESSARY. FOR RECEIVABLES ASSOCIATED WITH SELF-PAY PATIENTS (WHICH INCLUDES BOTH PATIENTS WITHOUT INSURANCE AND PATIENTS WITH DEDUCTIBLE AND COPAYMENT BALANCES DUE FOR WHICH THIRD-PARTY COVERAGE EXISTS FOR PART OF THE BILL), THE HEALTH SYSTEM RECORDS A SIGNIFICANT PROVISION FOR BAD DEBTS IN THE PERIOD OF SERVICE ON THE BASIS OF ITS PAST EXPERIENCE, WHICH INDICATES THAT MANY PATIENTS ARE UNABLE OR UNWILLING TO PAY THE PORTION OF THEIR BILL FOR WHICH THEY ARE FINANCIALLY RESPONSIBLE. 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: SEE THE "PATIENT ACCOUNTS RECEIVABLE" PARAGRAPH ON PAGE 9 OF THE AUDITED 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 2020 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 37,900. ITS SECONDARY SERVICE AREA COVERS 4 COUNTIES IN SOUTH DAKOTA AND 3 COUNTIES IN MINNESOTA WITH A POPULATION OF 48,500. 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. PART VI, LINE 7, REPORTS FILED WITH STATES SD 1 WATERTOWN AREA UNITED WAY PO BOX 283 WATERTOWN SD 57201 460359557 501(C)(3) 26250 SUPPORT OF UNITED WAY AGENCIES. LAKE AREA TECHNICAL INSTITUTE FOUNDATION PO BOX 730 WATERTOWN SD 57201 363860861 501(C)(3) 8925 SCHOLARSHIPS. HUMAN SERVICE AGENCY PO BOX 1030 WATERTOWN SD 57201 460275247 501(C)(3) 50000 DETOX UNIT SUPPORT WATERTOWN DEVELOPMENT CORP PO BOX 1267 WATERTOWN SD 57201 466012194 501(C)(6) 40000 SUPPORT NEW BUSINESS DEVELOPMENT SANFORD CLINIC 901 4TH STREET NW WATERTOWN SD 57201 460447693 501(C)(3) 15000 SUPPORT OF FAMILY PLANNING CLINIC. GLACIAL LAKES MULTICULTURAL CENTER 653 W KEMP AVE WATERTOWN SD 57201 834070282 501(C)(3) 5000 AGENCIES SUPPORT 6 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 SALEM MAALIKI MD PHYSICIAN 1224451 0 0 0 0 0 8400 0 25523 0 1258374 0 0 0 EVELIO GARCIA MD PHYSICIAN 1190691 0 101250 0 0 0 8400 0 24484 0 1324825 0 0 0 JEFFREY SMITH MD PHYSICIAN 658500 0 129195 0 0 0 8400 0 25523 0 821618 0 0 0 MIAN JAVAID MD PHYSICIAN 580138 0 35000 0 0 0 8400 0 19139 0 642677 0 0 0 LEIGHTON SINGH MD PHYSICIAN 588005 0 0 0 0 0 8400 0 25523 0 621928 0 0 0 KC DEBOER CHIEF EXECUTIVE OFFICER 329220 0 70000 0 0 0 22524 0 26675 0 448419 0 0 0 NATE LAKE VICE PRESIDENT 177377 0 53990 0 0 0 12814 0 25681 0 269862 0 0 0 GRANT TILLETT CHIEF INFORMATION OFFICER 169513 0 49607 0 0 0 14867 0 25523 0 259510 0 0 0 D ADAM POPP CHIEF FINANCIAL OFFICER 162382 0 58500 0 0 0 15656 0 19139 0 255677 0 0 0 TRACI RABINE VICE PRESIDENT 148287 0 53976 0 0 0 14430 0 25523 0 242216 0 0 0 MICHELE TURBAK CHIEF NURSING OFFICER 148043 0 55450 0 0 0 14859 0 19139 0 237491 0 0 0 A SOUTH DAKOTA HEALTH AND EDUCATIONAL FACILITIES AUTHORITY 460315509 2017-01-27 36000000 FUNDING OF THE NEW SPECIALTY CLINIC BUILDING 0 0 0 A 6030000 36000000 397999 35602001 2017 0 0 1 1 A 0 1 0 0 0 0 1 A 0 1 0 0 0 0 0 0 1 A 1 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 CATHERINE GERRISH IS A BOARD MEMBER AND THE MOTHER OF GREGORY GERRISH 648753 RESIDENCY STIPEND AND EMPLOYEE COMPENSATION 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 11B 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 ANNUALLY. THIS STATEMENT DISCLOSES ANY AREAS THAT MAY POTENTIALLY PRESENT A CONFLICT OF INTEREST WITH THEMSELVES OR FAMILY MEMBERS. THE CONFLICT OF INTEREST POLICY IS MONITORED BY THE CEO AND THE BOARD. MEMBERS WILL EXCUSE THEMSELVES DURING A BOARD MEETING FROM ANY DISCUSSION OR VOTING ON AN ISSUE WHERE THERE MAY BE A CONFLICT OF INTEREST. FORM 990, PART VI, SECTION B, LINE 15A COMPENSATION COMPARABILITY STUDIES ARE REVIEWED EACH YEAR FOR ALL POSITIONS BY THE HUMAN RESOURCES DEPARTMENT. THE HUMAN RESOURCES DEPARTMENT HAS ACCESS TO VARIOUS COMPENSATION SURVEYS, WHICH ARE REVIEWED TO DETERMINE IF THE HOSPITAL'S COMPENSATION IS REASONABLE COMPARED TO OTHER FACILITIES. THE BOARD APPROVES THE SALARY OF THE CEO THROUGH THE EXECUTIVE COMMITTEE, WHICH SERVES AS THE COMPENSATION COMMITTEE. THE BOARD DELEGATES VICE PRESIDENT EXECUTIVE COMPENSATION APPROVAL TO THE CEO BASED ON THE ORGANIZATION'S COMPENSATION PHILOSOPHY IN CONJUNCTION WITH MARKET BECHNMARKS. THE EXECUTIVE COMMITTEE REVIEWS AND APPROVES THE SALARIES OF OTHER KEY EMPLOYEES. THIS PROCESS WAS LAST COMPLETED IN 2019. FORM 990, PART VI, SECTION C, LINE 19 FINANCIAL STATEMENTS ARE AVAILABLE THROUGH FILINGS WITH BONDING AUTHORITY. GOVERNING DOCUMENTS AND THE CONFLICT OF INTEREST POLICY ARE NOT MADE AVAILABLE TO THE PUBLIC. FORM 990, PART XI, LINE 9: CHANGE IN BENEFICIAL INTEREST IN PRAIRIE LAKES FOUNDATION -81,549. PRAIRIE LAKES HOME CONNECTIONS INC 401 9TH AVE NW WATERTOWN SD 57201 460394984 HOMEMAKER & NURSING SERVICES SD 501(C)(3) LINE 10 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 69374 GAAP PRAIRIE LAKES HOME CONNECTIONS INC O 50414 GAAP