2020-07-15T17:07:09-05:00 2019-05-31 410746749 CLIFTONLARSONALLEN LLP 220 SOUTH SIXTH STREET SUITE 300 MINNEAPOLIS MN 55402 990 2018-06-01 460391067 PRAIRIE LAKES HEALTH CARE SYSTEM INC PRAI 6058827000 PO BOX 1210 WATERTOWN SD 57201 ADAM POPP CFO 6058827000 2020-07-15 1 ROBERT E SCHILE 6123764500 67.137.57.251 2020-07-15 13:10:11 CD P E168BB59A4AC1B98DF6FDFCBC72C1446FCA85D8B 39F506601BE52B1AEC27478C749FC3D7BEC65D0C 2018 2020-09-23 17:36:50Z KC DEBOER PO BOX 1210 WATERTOWN SD 57201 301477853 0 X WWW.PRAIRIELAKES.COM X 1986 SD PROVIDE HIGH QUALITY, AFFORDABLE & COMPASSIONATE HEALTHCARE SERVICES FOR THE PEOPLE IN THE REGION. 13 12 645 190 989863 250915 395556 632539 95150271 102566717 17511185 15332407 1716644 1528183 114773656 120059846 428079 293785 0 0 48200470 50433086 0 0 0 48667500 50050505 97296049 100777376 17477607 19282470 329183316 328290825 60880353 54681592 268302963 273609233 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 87717595 293785 102566717 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-THREE 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. 87717595 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 89 0 645 1 1 1 0 0 0 0 0 0 0 0 0 0 0 X 13 12 0 0 0 0 0 0 0 1 1 0 0 0 1 1 1 1 1 1 0 0 X ADAM POPP 6058827000 401 9TH AVENUE NW WATERTOWN SD 57201 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 DOUG SHARP SECRETARY 1.00 0.00 X X 0 0 0 VINCE FOLEY TREASURER 1.00 1.00 X X 0 0 0 MARK ROBY PAST CHAIR 1.00 0.00 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 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 SHANNON KRUSE BOARD MEMBER 1.00 0.00 X 0 0 0 STACEY LEE BOARD MEMBER 1.00 0.00 X 0 0 0 GERALD RIEBER MD BOARD MEMBER 1.00 0.00 X 0 0 0 KC DEBOER CHIEF EXECUTIVE OFFICER 40.00 1.00 X 135792 0 19537 JILL FULLER CEO (THROUGH AUGUST 2018) 40.00 1.00 X 1172184 0 17619 ADAM PAUL CFO (THROUGH NOVEMBER 2018) 40.00 1.00 X 232432 0 30089 D ADAM POPP CHIEF FINANCIAL OFFICER 40.00 1.00 X 207204 0 29905 MICHAEL ANDERSON CHIEF INVESTMENT OFFICER 40.00 0.00 X 379188 0 24525 NATE LAKE VICE PRESIDENT 40.00 1.00 X 236022 0 37523 TRACI RABINE VICE PRESIDENT 40.00 0.00 X 231829 0 36061 MICHELE TURBAK CHIEF NURSING OFFICER 40.00 0.00 X 238221 0 30192 GRANT TILLETT CHIEF INFORMATION OFFICER 40.00 0.00 X 221819 0 32797 SALEM MAALIKI MD PHYSICIAN 40.00 0.00 X 1452706 0 31932 EVELIO GARCIA MD PHYSICIAN 40.00 0.00 X 1324160 0 31932 JEFFREY SMITH MD PHYSICIAN 40.00 0.00 X 697776 0 31932 BIPIN AMIN MD PHYSICIAN 40.00 0.00 X 610000 0 25725 LEIGHTON SINGH MD PHYSICIAN 40.00 0.00 X 604808 0 31932 7744141 0 411701 48 0 1 0 COMPHEALTH PO BOX 972651 DALLAS TX 75397 LOCUM PHYSICIANS 951769 WAPITI MEDICAL GROUP 107 FLYNN DRIVE STE 600 MILBANK SD 57252 LOCUM ER PHYSICIANS 401121 WEATHERBY LOCUMS INC PO BOX 972633 DALLAS TX 75397 LOCUM PHYSICIANS 325420 DMS HEALTH TECHNOLOGIES PO BOX 670747 DALLAS TX 75267 PET SCAN 203794 MAYO COLLABORATIVE SERVICES PO BOX 9146 MINNEAPOLIS MN 55480 LAB SERVICES 165710 11 632539 632539 NET PATIENT SERVICE REVENUE 621400 101576854 101576854 RETAIL PHARMACY 446110 832676 832676 LAB SERVICE 621500 157187 157187 102566717 -174068 -174068 1069729 0 1069729 1069729 1069729 196912898 11584 181321640 96367 15591258 -84783 15506475 15506475 CAFETERIA REVENUE 722210 264476 264476 OTHER INCOME 900099 191809 191809 VENDING MACHINES 722210 1859 1859 310 310 458454 120059846 101576854 989863 16860590 293785 293785 2930868 2930868 40775264 37694886 3080378 910341 847721 62620 3046379 2742086 304293 2770234 2508215 262019 24259 24259 110926 110926 6996899 5548533 1448366 541794 541794 1515274 1046665 468609 729847 70458 659389 973380 22439 950941 476222 417324 58898 210510 101121 109389 774183 774183 6267057 4978703 1288354 403785 403785 UBI TAXES 52692 52692 MEDICAL SUPPLIES 11591515 11591515 DRUGS 11372044 11372044 PROVISION FOR BAD DEBT 4558120 4558120 3451998 2746012 705986 100777376 87717595 13059781 0 1573 1573 7533318 7528469 10794983 11761509 481528 543256 3155497 3127153 807293 919979 160708206 76648109 81966223 84060097 199971967 195398639 4820482 4217679 2481359 2392565 17169093 18339906 329183316 328290825 15519382 13546513 71097 38874579 34390295 1331918 887945 5154474 5785742 60880353 54681592 X 263785014 269695989 4517949 3913244 268302963 273609233 329183316 328290825 X 19282470 -13371495 -604705 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 3421875 3421875 85061170 26655262 58405908 2903610 2042133 861477 69136588 47950714 21185874 184963 184963 84060097 DUE FROM 457(B) PLAN 5107789 ACCRUED INTEREST RECEIVABLE 210967 TRUSTEE HELD FUNDS 248627 ACCRUED REAL ESTATE 10797298 DUE FROM RELATED PARTY 1975225 18339906 457(B) PAYABLE 5107789 LONG-TERM PTO 586053 ASSET RETIREMENT OBLIGATION 91900 5785742 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 1943938 0 1943938 0.02020 4584302 2528611 2055691 0.02140 6528240 2528611 3999629 0.04160 14032760 8359339 5673421 0.05900 14032760 8359339 5673421 0.05900 20561000 10887950 9673050 0.10060 19276 19276 0.00020 22370 22370 0.00020 41646 41646 0.00040 1 4558120 0 36486575 34300663 2185912 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 1 X 0 X 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 WWW.PRAIRIELAKES.COM/ABOUT-PRAIRIE-LAKES/COMMUNITY-BENEFITS-513.HTML. PRAIRIE LAKES HEALTH CARE SYSTEM PART V, SECTION B, LINE 11: DURING THE FISCAL YEAR ENDED MAY 31, 2019, 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. BEHAVIORAL HEALTH: PRAIRIE LAKES CURRENTLY: - SCREENS HOSPITAL PATIENTS TO ASSESS FOR RISK OF SELF-HARM - PROVIDES A MONTHLY GRIEF SUPPORT GROUP FOR COMMUNITY MEMBERS - OFFERS AN ANNUAL ALLOWANCE FOR AN ASSISTANCE PROGRAM TO EMPLOYEES AND THEIR IMMEDIATE FAMILY MEMBERS TO SEEK MENTAL HEALTH SERVICES - EDUCATE PATIENTS ON AVAILABLE MENTAL HEALTH SERVICES AND DISTRIBUTE LOCAL RESOURCE MATERIALS - HELPS COORDINATE A "MENTAL HEALTH FIRST AID TRAINING" THROUGH HUMAN SERVICE AGENCY (HSA) - ASSIST HSA WITH EFFORTS TO RECRUIT A PSYCHIATRIST - PROVIDES FINANCIAL SUPPORT TO: WATERTOWN SCHOOL DISTRICT "SEE SOMETHING, SAY SOMETHING" INITIATIVE, HSA SUICIDE PREVENTION SERVICED AND ANNUAL SUICIDE AWARENESS WALK, AND SERENITY HILLS, AN HSA RESIDENTIAL FACILITY AND SAFE HOUSE FOR THOSE SUFFERING FROM MENTAL ILLNESS OR ADDICTIONS2. TRANSPORTATIONPRAIRIE LAKES CURRENTLY: - PROVIDES FINANCIAL SUPPORT TO WATERTOWN AREA TRANSIT TO PROVIDE TRANSPORTATION FOR INDIVDUALS TO THEIR MEDICAL APPOINTMENTS3. CHRONIC DISEASE MANAGEMENTPRAIRIE LAKES CURRENTLY: - PROVIDES HEART AND STROKE SCREENING AT A REDUCED COST - PROVIDES REMOTE MONITORING OF CARDIAC PATIENTS - PROVIDES EDUCATION AND MONITORING OF HOME DIALYSIS PATIENTS - HAS RECRUITED A PULMONOLOGIST TO EXPAND RESPIRATORY SERVICES4. HEALTH LITERACYPRAIRIE LAKES CURRENTLY: - OFFERS VARIOUS HEALTH TALKS WITHIN THE COMMUNITY PRAIRIE LAKES HEALTH CARE SYSTEM PART V, SECTION B, LINE 16J: HTTPS://WWW.PRAIRIELAKES.COM/PATIENT-INFORMATION/FINANCIAL-ASSISTANCE-PROGRAM-510.HTML 4 1 - SISSETON SATELLITE DIALYSIS 5 EAST CHESTNUT SISSETON SD 57262 DIALYSIS UNIT 2 - MALLARD POINTE SURGICAL CENTER 1425 MICKELSON DRIVE WATERTOWN SD 57201 OUTPATIENT SURGERY CENTER 3 - ORTONVILLE SATELLITE DIALYSIS 450 EASTVOLD AVENUE ORTONVILLE MN 56278 DIALYSIS UNIT 4 - PRAIRIE LAKE PULMONOLOGY CLINIC 600 4TH STREET NE WATERTOWN SD 57201 PULMONOLOGY CLINIC PART I, LINE 3C: IN ADDITION TO INCOME BASED CRITERIA FOR DETERMINING THE AMOUNT OF FINANCIAL ASSISTANCE SERVICES FOR WHICH A PATIENT IS ELIGIBLE AT THE TIME OF SERVICE OR DURING THE BILLING-AND-COLLECTION PROCESS, PLHS USES AN ASSET TEST. ASSET EXCLUSIONS THAT ARE 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): $4,558,120 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 FOUNDATION, 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; AND THE BOYS AND GIRLS CLUB, WHICH PROVIDES RESOURCES FOR COMMUNITY YOUTH. 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 2019 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. PART VI, LINE 7, REPORTS FILED WITH STATES SD 1 BOYS & GIRLS CLUB OF WATERTOWN PO BOX 833 WATERTOWN SD 57201 460311845 501(C)(3) 125000 CAPITAL CAMPAIGN FOR FACILITY IMPROVEMENTS. WATERTOWN UNITED WAY PO BOX 283 WATERTOWN SD 57201 460359557 501(C)(3) 35000 SUPPORT OF UNITED WAY AGENCIES. LAKE AREA TECHNICAL INSTITUTE FOUNDATION PO BOX 730 WATERTOWN SD 57201 363860861 501(C)(3) 9000 SCHOLARSHIPS. HUMAN SERVICE AGENCY PO BOX 1030 WATERTOWN SD 57201 460275247 501(C)(3) 10000 DETOX UNIT SUPPORT WATERTOWN DEVELOPMENT CORP PO BOX 1267 WATERTOWN SD 57201 466012194 501(C)(6) 35000 ASSIST WITH BRINGING NEW BUSINESSES TO TOWN. SANFORD CLINIC 901 4TH STREET NW WATERTOWN SD 57201 460447693 501(C)(3) 15000 SUPPORT OF FAMILY PLANNING CLINIC. 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 0 0 0 0 0 0 0 0 0 KC DEBOER CHIEF EXECUTIVE OFFICER 112792 0 23000 0 0 0 4777 0 14760 0 155329 0 0 0 JILL FULLER CEO (THROUGH AUGUST 2018) 308984 0 863200 0 0 0 10038 0 7581 0 1189803 0 0 0 ADAM PAUL CFO (THROUGH NOVEMBER 2018) 232432 0 0 0 0 0 15072 0 15017 0 262521 0 0 0 D ADAM POPP CHIEF FINANCIAL OFFICER 183767 0 23437 0 0 0 7085 0 22820 0 237109 0 0 0 MICHAEL ANDERSON CHIEF INVESTMENT OFFICER 229188 0 150000 0 0 0 12864 0 11661 0 403713 0 0 0 NATE LAKE VICE PRESIDENT 184109 0 51913 0 0 0 13841 0 23682 0 273545 0 0 0 TRACI RABINE VICE PRESIDENT 179929 0 51900 0 0 0 12379 0 23682 0 267890 0 0 0 MICHELE TURBAK CHIEF NURSING OFFICER 184904 0 53317 0 0 0 12717 0 17475 0 268413 0 0 0 GRANT TILLETT CHIEF INFORMATION OFFICER 174121 0 47698 0 0 0 9977 0 22820 0 254616 0 0 0 SALEM MAALIKI MD PHYSICIAN 1445206 0 7500 0 0 0 8250 0 23682 0 1484638 0 0 0 EVELIO GARCIA MD PHYSICIAN 1217160 0 107000 0 0 0 8250 0 23682 0 1356092 0 0 0 JEFFREY SMITH MD PHYSICIAN 697776 0 0 0 0 0 8250 0 23682 0 729708 0 0 0 BIPIN AMIN MD PHYSICIAN 610000 0 0 0 0 0 8250 0 17475 0 635725 0 0 0 LEIGHTON SINGH MD PHYSICIAN 604808 0 0 0 0 0 8250 0 23682 0 636740 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 B SOUTH DAKOTA HEALTH AND EDUCATIONAL FACILITIES AUTHORITY 460315509 2017-01-27 36000000 FUNDING OF THE NEW SPECIALTY CLINIC BUILDING 0 0 0 A 18095000 25166290 3303 431508 24731480 2010 1 1 1 1 B 3965000 36000000 397999 35602001 2017 0 0 1 1 B 0 0 0 0 0 0 1 A 0 0 0 1 0 0 0 0 1 B 0 1 0 0 0 0 0 0 1 A 1 B 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 CATHERINE GERRISH IS A BOARD MEMBER AND THE MOTHER OF GREGORY GERRISH 448606 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 INTREST 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 2018. 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 -604,705. 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 95061 GAAP PRAIRIE LAKES HOME CONNECTIONS INC O 115410 GAAP