2017-07-27T13:18:08-05:00 2016-09-30 450250958 EIDE BAILLY LLP 4310 17TH AVE S PO BOX 2545 FARGO ND 581082545 990 2015-10-01 411763968 Prairie Ridge Hospital and Health Services Inc PRAI 2186857300 1411 Highway 79 E Elbow Lake MN 56531 Jim Gingerich CEO 2186857300 2017-07-26 1 LISA CHAFFEE CPA P00193453 7012398500 2017-07-26 2015 2021-01-29 14:40:06Z Jim Gingerich 1411 Highway 79 E Elbow Lake MN 56531 17387249 0 X www.prairiehealth.org X 1993 MN An acute care hospital and ambulatory outpatient facility. 7 6 162 0 0 0 175441 128886 14204946 17165270 60509 34570 3383 1343 14444279 17330069 0 0 0 0 4363271 5794990 0 0 0 10417282 12297272 14780553 18092262 -336274 -762193 33074223 31451284 25267408 24321710 7806815 7129574 Serving the healthcare needs of the people. 0 0 14195184 17165270 Prairie Ridge Hospital and Health Services (Medical Center) maintains and operates a hospital and an ambulatory outpatient facility for the care and treatment of the sick, diseased, disabled, aged or indigent persons and participates in various activities to promote the general health of the community. The Medical Center operates various provider based clinics and a provider based surgery department. The Medical Center maintains records to identify and monitor the level of charity care it provides. These records include the amount of charges foregone for services and supplies furnished under its charity care policy. The amount of charges foregone, based on established rates were $53,354 and $30,623 during the years ended September 30, 2016 and September 30, 2015. 14195184 1 1 0 0 0 0 0 0 0 1 1 0 0 0 1 1 0 1 0 0 0 0 0 0 0 0 1 1 0 0 1 0 0 0 0 0 0 0 1 0 0 0 0 1 1 1 0 0 0 1 35 0 1 162 1 0 0 0 0 0 0 0 0 0 0 X 7 6 1 0 0 0 1 1 1 1 0 0 0 1 1 1 1 1 1 0 0 0 MN X Alison Rein 2186857337 1411 Highway 79 E Elbow Lake MN 56531 X Shawn Larsen Chair (Jan-Jun) 1.00 0.00 X X 1200 0 0 Gene Wenstrom Chair (Jul-Sept) 1.00 0.00 X X 0 0 0 David Bjork Dir (Oct-Apr)/ Vice Chair (May-Sept) 1.00 0.00 X X 1200 0 0 Sandy Alvstad Secretary 1.00 0.00 X X 1200 0 0 Scott SwensonTreasurer Director (Oct-Apr)/Treas (May-Jun) 1.00 0.10 X X 600 0 0 Dustin Sperr Director 1.00 0.00 X 1200 0 0 Gary Spies Director 1.00 0.00 X 1200 0 0 Jay McNamar Director 1.00 0.00 X 900 0 0 Jim Gingerich CEO (Aug-Sep) 40.00 0.00 X 0 21819 0 Brett Longtin CFO (Oct-Sept)/CEO (Oct-Nov)(Jul) 0.00 40.00 X 0 232513 18842 Lawrence Blue CEO (Nov-Jun) 40.00 0.00 X 0 21346 0 Dustin Sperr CMO (Jan-Sep) 1.40 0.00 X 0 0 0 David Bjork CMO (Oct-Dec) 9.00 0.00 X 0 0 0 Loraine Martineau Controller (Oct-Aug) 40.00 0.00 X 96559 0 3354 Barbara Moore Physical Therapist 40.00 0.00 X 110015 0 12474 Renae Lien Pharmacy Director 40.00 0.00 X 129351 0 2618 Thomas Kooiman Former CEO 40.00 0.00 X 0 219828 941 343425 495506 38229 2 1 1 0 Lake Region Healthcare Co 712 S Cascade St Fergus Falls MN 56538 Professional/Physician Services 2959424 CPSI 6600 Wall Street Mobile AL 36695 IT Support 882796 West Central Internal Medicine PO Box 410 Morris MN 56267 Physician Services 454178 Morris Electronics Inc 511 Atlantic Ave Morris MN 56267 IT Services 408087 DMS Imagining Inc PO Box 206143 Dallas TX 75320 Radiology Services 279224 13 30000 98886 128886 Net Patient Service Rev. 622110 16139431 16139431 Pharmacy 722320 760666 760666 Other Revenue 900099 287614 287614 Rural Alliance Investment 900099 -22441 -22441 17165270 91750 91750 1343 0 1343 1343 1343 57180 -57180 -57180 -57180 17330069 17165270 0 35913 X 123885 123885 4856734 3383510 1473224 101571 70761 30810 346862 241646 105216 365938 249187 116751 60406 60406 74863 74863 5223377 4001858 1221519 88571 88571 592145 475009 117136 425976 36415 389561 53212 44905 8307 23617 21094 2523 847432 847432 2032996 2032996 133491 133491 Medical Supplies 1943126 1943126 Repairs and Maintenance 436682 382511 54171 MN Health Tax 179595 179595 Bad Debt Expense 104715 104715 77068 46933 30135 18092262 14195184 3897078 0 1206366 1901977 4268596 4295865 153189 290536 201230 225525 28678751 6640861 23928347 22037890 2120665 2402252 98208 81094 1097622 216145 33074223 31451284 2064181 1412097 23203227 22532713 0 376900 25267408 24321710 X 7534281 6845750 42986 54276 229548 229548 7806815 7129574 33074223 31451284 -762193 84952 0 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 270034 13790 283824 315032 -4998 40000 270034 309625 5407 315032 284404 25221 309625 281494 2910 284404 0.80880 0.19120 0 0 570277 570277 21340855 2925163 18415692 6759619 3715698 3043921 8000 8000 22037890 Due to Third Party Payor 376900 376900 X 17310306 84952 -104715 -19763 17330069 0 17330069 17987547 0 17987547 104715 104715 18092262 Part V, Line 4: Endowment funds are intended to earn investment income. The investment income is intended to be used for funding operational expenses. Part X, Line 2: PRHHS is organized as a Minnesota nonprofit corporation and has been recognized by the Internal Revenue Service (IRS) as exempt from federal income taxes under Internal Revenue Code Section 501(c)(3). PRHHS is annually required to file a Return of Organization Exempt from Income Tax (Form 990) with the IRS. In addition, PRHHS is subject to income tax on net income that is derived from business activities that are unrelated to their exempt purpose. PRHHS has determined they are not subject to unrelated business income tax and has not filed an Exempt Organization Business Income Tax Return (Form 990T) with the IRS. PRHHS believes that it has appropriate support for any tax positions taken affecting its annual filing requirements, and as such, does not have any uncertain tax positions that are material to the consolidated financial statements. PRHHS would recognize future accrued interest and penalties related to unrecognized tax benefits and liabilities in income tax expense if such interest and penalties are incurred. Part XI, Line 2d - Other Adjustments: Bad Debt Expense Included in Expenses in Financial Statements -104,715. Part XII, Line 4b - Other Adjustments: Bad Debt Expense Included in Revenue in Financial Statements 104,715. 1 1 X 1 X 1 X 280.000000000000 1 0 1 1 42000 42000 0.00230 2740938 2300085 440853 0.02450 2782938 2300085 482853 0.02680 115105 13395 101710 0.00570 5934655 4231367 1703288 0.09470 6049760 4244762 1804998 0.10040 8832698 6544847 2287851 0.12720 0 104715 12985 6462468 6827598 -365130 X 1 1 1 1 Prairie Ridge Hospital & Health Services 1411 Highway 79 E Elbow Lake MN 56531 www.prairiehealth.org 00154 X X X X 4 provider based clinics Prairie Ridge Hospital and Health Servic 1 0 0 1 X X X X X X X X X 15 1 0 0 1 X http://www.prairiehealth.org X 1 15 1 http://www.prairiehealth.org 0 0 1 X 200.000000000000 280.000000000000 X X 1 1 X X X X 1 X http://www.prairiehealth.org X http://www.prairiehealth.org X http://www.prairiehealth.org X X X X X X 1 X 0 X X 1 X 0 0 Prairie Ridge Hospital and Health Service Part V, Section B, Line 5: We put together a committee of community members comprised of:A Prairie Ridge board member, area director of public health, a licensed social worker with an area nursing home, a branch manager with a home healthcare agency, the facilitator with a child and youth council, the counselor for the area school district, a former teacher, the county social services director, and the dean of students for the local school district.We met several times in order to identify what needs our area has. We also conducted a public survey via handout and the internet in order to get outside feedback. Prairie Ridge Hospital and Health Service Part V, Section B, Line 11: The Hospital is addressing the needs listed below which were identified in the 2015 tax year CHNA. Due to the timing of the tax year end and the completion date of the CHNA and Implementation Strategy some initiatives were not taken by year end, but the future actions are addressed below.1) Preventative CareCurrent activities * Prairie Ridge has a practitioner with an interest in diabetes. * She holds a free monthly diabetic education support group that covers a variety of topics for those who have diabetes and their loved ones. * Through the diabetic education program we offer a free membership to the Prairie Ridge Fitness to qualifying members. * Prairie Ridge works with Lake Region Healthcare dieticians on addressing dietary issues in the community and with our patients. * Prairie Ridge has put into place additional screening for well child exams in order to identify potential issues early on. * Prairie Ridge operates a 24/7 fitness center that is open to the community. * We work with a wide variety of insurance programs in order to allow access to as many members of the community as we can. * Prairie Ridge contracts with 4 area school districts to provide school nursing. * Prairie Ridge has 5 locations in order to provide better access to care.Proposed activitiesConducted by hospital * Prairie Ridge will add a second evening clinic to allow better access to healthcare. * Resources Committed * Staff time * Financial resources * Anticipated Impact * Having additional extended hours will allow further access to our clinic and cut down on non-emergency ER visits. * Prairie Ridge will open an additional satellite clinic in Herman in March of 2017 which will increase access to healthcare. * Resources Committed * Staff time * Financial resources * Anticipated Impact * Increase access to healthcare services within the communities we serve.Collaboration with others (if applicable) * Prairie Ridge Fitness * Lake Region Healthcare2) Aging PopulationCurrent activities * Prairie Ridge hired a nurse specifically to work with our aging population. * The services provided by the nurse include annual wellness visit reminders. * Chronic Care Management provides a care coordinator for patients with multiple diagnoses. * This nurse visits with area senior groups to educate them on services available to them. * Prairie Ridge has partnered with the PAD PRAIRIE initiative and has received training to perform screenings on patients to better diagnose PAD. * Implemented Transitional Care Management which helps manage the care after discharge. * Prairie Ridge offers swing bed services.Conducted by others * Prairie Ridge has partnered with the PAD PRAIRIE initiative. * Promoted community awareness of PAD through community events * Facilitated screening and identification of PAD * Home health agency provides services in the area * City operates an elderly independent living facility * Nursing homes in Barret and Evansville provide assisted livingProposed activities * Prairie Ridge will continue to provide the services listed above. * Resources Committed * Staff time * Financial Resources * Anticipated Impact * This will help us to better serve the needs of our aging population. * Prairie Ridge does not plan to engage in any additional programs related to elderly care during the current period as it is not currently in a financial position to address this issue. In addition, as noted above, others in the community currently are addressing it.Collaboration with others (if applicable) * PAD PRAIRIE Initiative * Grant County Committee of Aging3) Mental and Behavioral Health ServicesCurrent activities * The school district has providers who come in to meet with students. * Prairie Ridge has a contract with Bridgeway Behavioral Health at Lake Region Healthcare. * Prairie Ridge works with the Region 4 Mental Health Crisis team. * Prairie Ridge conducts continued education with staff in dealing with mental health and behavior health patients.Proposed activities * Prairie Ridge is working on policies and procedures to turn one of our hospital rooms into a safe room for mental health and behavior health patients. * Resources Committed * Staff time * Financial Resources * Anticipated Impact * This will help us to create a safe environment for our patients dealing with mental and/or behavioral health issues. * Prairie Ridge will continue to contract with Bridgeway Behavioral Health to provide services for patients with mental/behavioral health issues * Resources Committed * Staff time * Anticipated Impact * This will allow us to better serve our patients by referring them to the care that will best serve their needs. * Prairie Ridge will continue to ensure practitioners are aware of the signs of mental health issues and encourage them to refer to specialists. * Resources Committed * Staff time * Anticipated Impact * This will help practitioners to better serve and treat our patients. * Prairie Ridge will continue to educate patients about the services available to them. * Resources Committed * Staff time * Anticipated Impact * This will allow us to better serve our patients by connecting them with the correct services to best address their needs.4) TransportationCurrent activities * Rainbow Rider provides transportation services in the community, however hours of service are limited * The Veteran's Association provides transportation services to its members. * Grant County Committee on Aging's Volunteer Driver Program exists to drive people to appointments. * Prairie Ridge educates patients as to what services are available to them to help them with transportation.Proposed activities * Prairie Ridge does not plan to engage in any additional programs related to transportation during the current period as it is not currently in a financial position to address this issue. In addition, as noted above, others in the community currently are addressing it.Collaboration with others (if applicable) * Rainbow Rider * Veteran's Association * Grant County COmmittee on Aging's Volunteer Driver Program5) Dental Care for Low Income FamiliesCurrent activities * Prairie Ridge helps promote the free dental services that are offered for area families.Proposed activities * Prairie Ridge does not plan to engage in any additional programs related to Dental Care during the current period as it is not currently in a financial position to address this issue.Collaboration with others (if applicable) * Grant County Child and Youth Council * Apple Tree Dental Outreach Clinic Prairie Ridge Hospital and Health Service Part V, Section B, Line 16i: The Hospital provided a summary of the financial assistance policy with the patient billing invoices, posted a summary in the emergency rooms and waiting rooms, as well as the admissions office and their website. The full policy was available upon request. Prairie Ridge Hospital and Health Service Part V, Section B, Line 22d: The Hospital uses the Lookback Method to calculate the amounts generally billed. Part I, Line 3c: If a patient's income exceeds 200% of the FPG, discounted care is provided on a pro-rated basis. For example, a patient with income of 220% of the FPG might be eligible for an 80% discount. Total income and liquid assets are analyzed when assessing a patient's eligibility for discounted care. Once a patient exceeds 280% of the FPG, they are no longer eligible for financial assistance. Part I, Line 6a: The annual community benefit report is available to the public upon request and on the PRHHS website. Part I, Line 7: Charity care was converted to cost by multiplying the ratio of cost to charges for the Hospital by the gross uncompensated charges associated with providing charity care to its patients. Medicaid is reported at cost according to the amounts on the Medicaid Cost Report. Community health improvement services and donations are reported based on actual expenses recorded to the general ledger. Subsidized health services are reported according to costs allocated to the relevant cost centers on the Medicare Cost Report. Part I, Ln 7 Col(f): The amount of bad debt expense removed from the denominator of the calculation was $104,715. Part III, Line 2: Bad debt expense on line 2 is reported at charges as presented on the financial statements. A payment on an account previously written off reduces bad debt expense in the current year. Part III, Line 3: The estimated amount of bad debt expense attributable to patients eligible under the organization's charity care policy is calculated by using the ratio of the population in the service area that is below the FPG of 12.4% to the total population and multiplying that percentage times the bad debt expense at cost. Part III, Line 4: The footnote to the Organization's financial statements can be found on page 9 of the attached audited financial statements. Part III, Line 8: Medicare allowable costs of care are based on the Medicare cost report. The Medicare cost report is completed based on the rules and regulations set forth by Centers for Medicare and Medicaid Services.Prairie Ridge Hospital and Health Services is a critical access hospital and in prior years has not shown a Medicare shortfall. There was a shortfall for 2015 and 2014 due to sequestration. Even though Medicare was at a loss, the Hospital provides services to these patients because access to healthcare and individual's health is important to the Hospital. Therefore, the Medicare shortfall is considered a community benefit. Part III, Line 9b: For patients unable to meet the collection guidelines of Prairie Ridge Hospital and Health Services, notice of the Charity Care Program and appropriate forms (including the financial disclosure statement) will be supplied to the patient for completion and consideration in satisfying the balance remaining due. Once the patient begins the application process, the Hospital ceases all collection action on the amounts being considered for financial assistance. If there is a payment made on the account during the application process, the payment is applied directly to the account balance. Individuals are given 240 days to complete the FAP application. Part VI, Line 2: In addition to the CHNA process that took part in tax year 2015, the organization assesses the health care needs of the community based on feedback from physicians. Part VI, Line 3: Information regarding charity care is available in admission areas and in clinic patient rooms. If a patient is past due on a bill, an additional notification is given to the patient to contact the hospital to discuss payment options, including charity care. The hospital provides counseling to patients to help them qualify for Medicaid. Part VI, Line 4: Prairie Ridge Hospital and Health Services service area includes Grant County and surrounding counties in Minnesota. In 2015, the population for Grant County was estimated to be 5,903. In 2014, approximately 23.3% of the population is age 65 or older. The average per capita income is $27,195 and approximately in 2013 12.4% of the population is below the federal poverty level. The nearest hospital in the area is approximately 20 miles from Prairie Ridge Hospital and Health Services main campus. Part VI, Line 5: The Organization's governing body is comprised of volunteer members who reside in the community. Medical staff privileges are extended to all qualified physicians in the community. Surplus funds are reinvested in facilities to improve patient care. The hospital operates an emergency room that is available to all, regardless of ability to pay.Prairie Ridge Hospital and Health Services (PRHHS) is the sole healthcare provider within the Elbow Lake Community. The satellite clinics located in Ashby, Evansville and Hoffman provide clinic and lab services. The Morris satellite clinic provides outpatient surgery, clinic, lab and radiology services to the Morris area.PRHHS supports the education and training of various healthcare professionals. Nurse Practitioner, Physician Assistant, Radiology, Physical Therapy and nursing professionals-in-training shadow PRHHS providers during their various internships.In keeping with the hospital's mission of "Serving the healthcare needs of the people" PRHHS provides:Support Groups - PRHHS provides free use of the facility for support groups on a monthly basis. Groups include: Grief Support and Diabetic SupportTransportation - To facilitate transportation for patients in Morris to the Prairie Ridge Morris facility, PRHHS pays a monthly stipend to a public transit that allows those patients to attend their appointments without paying transportation costs.Ambulance - PRHHS Ambulance and Emergency Staff are present in case of emergency at local school activities such as football, wrestling, etc. In addition they are present at county fairs and other local events.Blood Pressure Checks - Free blood pressure checks are available at all times in both the clinic and hospital setting at all PRHHS sites. These checks are at no cost to the patient whether or not they are an established patient.Expos - PRHHS participates in the Grant County and Stevens County Fairs where we provide various information.Sports Physicals - School sports physicals are performed at a reduced rate for the schools in our area.Spry - Spry is a publication sponsored by PRHHS that provides various health related information on various topics including a variety of conditions as well as information on maintaining good health.Community Pages - Listed through the community pages are the various support groups and any health related activities provided at various times for various occasions (i.e. Community Safety, Drug Education, etc.). Part VI, Line 7, Reports Filed With States MN 0 0 0 0 0 0 0 0 0 Brett Longtin CFO (Oct-Sept)/CEO (Oct-Nov)(Jul) 0 208111 0 24402 0 0 0 7636 0 11206 0 251355 0 0 Thomas Kooiman Former CEO 0 219828 0 0 0 0 0 0 0 941 0 220769 0 0 Morris Electronics Inc Board Chair Shawn Larsen is 100% owner 253321 IT Services 0 Form 990, Part VI, Section A, line 2 Jim Gingerich, Dr. Dustin Sperr, Dr. David Bjork, Brett Longtin, and Gene Wenstrom all have a business relationship. Form 990, Part VI, Section A, line 6 Lake Region Healthcare Corporation ("Lake Region"), a Minnesota nonprofit corporation, shall be the sole corporate member of the Corporation. Form 990, Part VI, Section A, line 7a Lake Region has reserved exclusively to itself the power to appoint board members from a slate of candidates nominated by the Corporation's Board. Form 990, Part VI, Section A, line 7b Lake Region has reserved exclusively to itself the following reserved powers: a. Approval of Operating and Capital Budget recommended by the Corporation's Board; b. Approval of Strategic Plan recommended by the Corporation's Board; c. Approval of any recommendation by the Corporation's Board to substantially change its purpose or mission or to transfer assets; d. Amendment of Articles of Incorporation, Bylaws, and other Corporate Documents; e. Approval of Contracts involving Physicians or other Providers, for compliance purposes only; f. Board member appointment, for a slate of candidates nominated by the Corporation's Board; g. Approval of incurrence of debt in excess of thresholds established by Lake Region policy; h. Approval of joint ventures or partnerships proposed to be entered into by the Corporation; and i. Approval of the creation by the Corporation of any new corporation, limited liability company, or other entity. Form 990, Part VI, Section A, line 8b Currently the organization does not have any committees with the authority to act on behalf of the governing body. Form 990, Part VI, Section B, line 11 The return was reviewed by the CEO and CFO, followed by a review of the Board of Directors prior to filing. Form 990, Part VI, Section B, line 12c The conflict of interest policy is reviewed on an annual basis by the Board of Directors. Board members, officers and management personnel are asked to disclose any potential conflicts. Any potential conflicts are reviewed at that time, and any actual conflicts are noted in the meeting minutes. Any person with a conflict is restricted from voting on related matters. Form 990, Part VI, Section B, line 15 The compensation for the CEO is determined annually by the related management company, Lake Region Healthcare. Form 990, Part VI, Section C, line 19 The Organization's governing documents, conflict of interest policy, and financial statements are available to the public upon request. Form 990, Part VII: The compensation reported on Part VII for the former CEO Thomas Kooiman is related to services he provides to the related organization, Lake Region Healthcare Corporation, as an employee to LRHC. It is not for services provided to the filing organization. Form 990, Part IX, line 11g Consulting Services: Program service expenses 17,725. Management and general expenses 3,669. Fundraising expenses 0. Total expenses 21,394. Physician Fees: Program service expenses 2,476,079. Management and general expenses 0. Fundraising expenses 0. Total expenses 2,476,079. Purchased Services: Program service expenses 1,477,456. Management and general expenses 1,194,315. Fundraising expenses 0. Total expenses 2,671,771. Miscellaneous: Program service expenses 30,598. Management and general expenses 23,535. Fundraising expenses 0. Total expenses 54,133. Pharm Care LLC 1411 Highway 79 E Elbow Lake MN 56531 411763968 Retail Pharmacy MN 0 0 Prairie Ridge Hospital and Health Services Inc Prairie Ridge Foundation Inc 1411 Highway 79 E Elbow Lake MN 56531 455092280 Supporting Organization MN 501(c)(3) Line 7 Prairie Ridge Hospital and Health Services Inc 1 Lake Region Healthcare Corporation 712 S Cascade St Fergus Falls MN 565380728 410730602 Hospital MN 501(c)(3) Line 3 N/A 0 Lake Region Hospital Foundation 712 S Cascade St Fergus Falls MN 565380728 411677288 Foundation MN 501(c)(3) Line 11a, I Lake Region Healthcare Corporation 0 LRHC Long Term Care Facilities Inc 712 S Cascade St Fergus Falls MN 565380728 411817549 Assisted Living MN 501(c)(3) Line 9 Lake Region Healthcare Corporation 0 LRH RAD ONC Services 712 S Cascade St Fergus Falls MN 565380728 271322270 Radiation Oncology Services MN N/A Lake Region Home Medical Supply 712 S Cascade St Fergus Falls MN 565380728 464182501 Medical Equipment Sales MN N/A Lakes Area Community Health Plan 712 S Cascade St Fergus Falls MN 565380728 460952511 Health Insurance Services MN N/A 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0