LAKE REGION HEALTHCARE CORPORATION: Form 990, tax year 2014
View the entire original 990 at ProPublica ↗
- Organization
- LAKE REGION HEALTHCARE CORPORATION (EIN 41-1763968)
- Tax period
- 2014-01-01 to 2014-12-31
- Filed
- 2015-10-29
- IRS object ID
- 201523029349301402
- Schema version
- 2014v5.0
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2015-10-29T09:47:05-05:00 | ReturnTs |
| Tax Period End | 2014-12-31 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 450250958 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | EIDE BAILLY LLP | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 4310 17TH AVE S PO BOX 2545 | AddressLine1Txt |
| City | FARGO | CityNm |
| State Abbreviation | ND | StateAbbreviationCd |
| ZIP | 581082545 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2014-01-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 411763968 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Prairie Ridge Hospital and Health Services Inc | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | PRAI | BusinessNameControlTxt |
| Phone | 2186854461 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1411 Highway 79 E | AddressLine1Txt |
| City | Elbow Lake | CityNm |
| State Abbreviation | MN | StateAbbreviationCd |
| ZIP | 56531 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | Brett Longtin | PersonNm |
| Person Title | Interim CEO | PersonTitleTxt |
| Phone | 2186854461 | PhoneNum |
| Signature | 2015-10-28 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | LISA CHAFFEE CPA | PreparerPersonNm |
| PTIN | P00193453 | PTIN |
| Phone | 7012398500 | PhoneNum |
| Preparation | 2015-10-28 | PreparationDt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2014 | TaxYr |
| Build TS | 2016-02-25 16:41:14Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | Brett Longtin | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1411 Highway 79 E | AddressLine1Txt |
| City | Elbow Lake | CityNm |
| State Abbreviation | MN | StateAbbreviationCd |
| ZIP | 56531 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $17,823,027 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | www.prairiehealth.org | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1993 | FormationYr |
| Legal Domicile State | MN | LegalDomicileStateCd |
| Activity Or Mission | An acute care hospital and ambulatory outpatient facility. | ActivityOrMissionDesc |
| Voting Members Governing Body | 6 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 5 | VotingMembersIndependentCnt |
| Total Employee | 172 | TotalEmployeeCnt |
| Total Volunteers | 0 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $185,511 | PYContributionsGrantsAmt |
| CY Contributions Grants | $777,120 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $15,284,226 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $16,941,233 | CYProgramServiceRevenueAmt |
| PY Investment Income | $64,361 | PYInvestmentIncomeAmt |
| CY Investment Income | $94,104 | CYInvestmentIncomeAmt |
| PY Other Revenue | $1,408 | PYOtherRevenueAmt |
| CY Other Revenue | $1,200 | CYOtherRevenueAmt |
| PY Total Revenue | $15,535,506 | PYTotalRevenueAmt |
| CY Total Revenue | $17,813,657 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $0 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $0 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $5,154,671 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $5,452,049 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $9,424,233 | PYOtherExpensesAmt |
| CY Other Expenses | $12,047,848 | CYOtherExpensesAmt |
| PY Total Expenses | $14,578,904 | PYTotalExpensesAmt |
| CY Total Expenses | $17,499,897 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $956,602 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $313,760 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $28,340,987 | TotalAssetsBOYAmt |
| Total Assets EOY | $33,933,544 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $20,306,852 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $25,624,994 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $8,034,135 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $8,308,550 | NetAssetsOrFundBalancesEOYAmt |
| Mission | Serving the healthcare needs of the people. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $14,232,280 | ExpenseAmt |
| Revenue | $16,941,233 | RevenueAmt |
| Desc | 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 $47,956 and $122,017 during the years ended December 31, 2014 and 2013. | Desc |
| Total Program Service Expenses | $14,232,280 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (1) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (1) | ScheduleBRequiredInd |
| Political Campaign Acty | 0 | PoliticalCampaignActyInd |
| Lobbying Activities | 0 | LobbyingActivitiesInd |
| Subject To Proxy Tax | 0 | SubjectToProxyTaxInd |
| Donor Advised Fund | 0 | DonorAdvisedFundInd |
| Conservation Easements | 0 | ConservationEasementsInd |
| Collections Of Art | 0 | CollectionsOfArtInd |
| Credit Counseling | 0 | CreditCounselingInd |
| Temp Or Permanent Endowments | Yes (1) | TempOrPermanentEndowmentsInd |
| Report Land Building Equipment | Yes (1) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | 0 | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | 0 | ReportProgramRelatedInvstInd |
| Report Other Assets | 0 | ReportOtherAssetsInd |
| Report Other Liabilities | 0 | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | Yes (1) | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | 0 | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | Yes (1) | ConsolidatedAuditFinclStmtInd |
| School Operating | 0 | SchoolOperatingInd |
| Foreign Office | 0 | ForeignOfficeInd |
| Foreign Activities | 0 | ForeignActivitiesInd |
| More Than5000 K To Org | 0 | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividualsInd |
| Professional Fundraising | 0 | ProfessionalFundraisingInd |
| Fundraising Activities | 0 | FundraisingActivitiesInd |
| Gaming Activities | 0 | GamingActivitiesInd |
| Operate Hospital | Yes (1) | OperateHospitalInd |
| Audited Financial Stmt Att | Yes (1) | AuditedFinancialStmtAttInd |
| Grants To Organizations | 0 | GrantsToOrganizationsInd |
| Grants To Individuals | 0 | GrantsToIndividualsInd |
| Schedule J Required | 0 | ScheduleJRequiredInd |
| Tax Exempt Bonds | 0 | TaxExemptBondsInd |
| Engaged In Excess Benefit Trans | 0 | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | 0 | PYExcessBenefitTransInd |
| Loan Outstanding | 0 | LoanOutstandingInd |
| Grant To Related Person | 0 | GrantToRelatedPersonInd |
| Business Rln With Org Mem | 0 | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | 0 | BusinessRlnWithFamMemInd |
| Business Rln With Officer Ent | Yes (1) | BusinessRlnWithOfficerEntInd |
| Deductible Non Cash Contri | 0 | DeductibleNonCashContriInd |
| Deductible Art Contribution | 0 | DeductibleArtContributionInd |
| Terminate Operations | 0 | TerminateOperationsInd |
| Partial Liquidation | 0 | PartialLiquidationInd |
| Disregarded Entity | Yes (1) | DisregardedEntityInd |
| Related Entity | Yes (1) | RelatedEntityInd |
| Related Organization Ctrl Ent | Yes (1) | RelatedOrganizationCtrlEntInd |
| Transaction With Control Ent | Yes (1) | TransactionWithControlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | 0 | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| IRP Document | 36 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (1) | BackupWthldComplianceInd |
| Employee | 172 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (1) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | 0 | UnrelatedBusIncmOverLimitInd |
| Foreign Financial Account | 0 | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | 0 | TaxablePartyNotificationInd |
| Nondeductible Contributions | 0 | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributionsInd |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOfInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | 0 | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | 0 | PayPremiumsPrsnlBnftCntrctInd |
| Indoor Tanning Services | 0 | IndoorTanningServicesInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 6 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 5 | IndependentVotingMemberCnt |
| Family Or Business Rln | Yes (1) | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | Yes (1) | DelegationOfMgmtDutiesInd |
| Change To Org Documents | 0 | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | 0 | MembersOrStockholdersInd |
| Election Of Board Members | 0 | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | 0 | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (1) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | 0 | MinutesOfCommitteesInd |
| Officer Mailing Address | 0 | OfficerMailingAddressInd |
| Local Chapters | 0 | LocalChaptersInd |
| Form990 Provided To Gvrn Body | Yes (1) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (1) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (1) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (1) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (1) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (1) | DocumentRetentionPolicyInd |
| Compensation Process CEO | 0 | CompensationProcessCEOInd |
| Compensation Process Other | 0 | CompensationProcessOtherInd |
| Investment In Joint Venture | 0 | InvestmentInJointVentureInd |
| States Where Copy Of Return Is Fld | MN | StatesWhereCopyOfReturnIsFldCd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Loraine Martineau | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 2186857343 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1411 Highway 79 E | AddressLine1Txt |
| City | Elbow Lake | CityNm |
| State Abbreviation | MN | StateAbbreviationCd |
| ZIP | 56531 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (11 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Highest Compensated EmployeeHighestCompensatedEmployeeInd |
|---|---|---|---|---|---|---|---|---|
| Gene Wenstrom | ||||||||
| Chair | 1.00 | 0.10 | Yes (X) | Yes (X) | $1,200 | $0 | $0 | |
| John Peterson | ||||||||
| Vice Chair (January-April) | 1.00 | 0.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| Sandy Alvstad | ||||||||
| Secretary | 1.00 | 0.00 | Yes (X) | Yes (X) | $1,200 | $0 | $0 | |
| Wes Moir | ||||||||
| Director | 1.00 | 0.00 | Yes (X) | $1,200 | $0 | $0 | ||
| Shawn Larsen | ||||||||
| Director | 1.00 | 0.00 | Yes (X) | $1,200 | $0 | $0 | ||
| David Bjork | ||||||||
| Director/CMO | 8.50 | 0.00 | Yes (X) | $1,200 | $0 | $0 | ||
| Dustin Sperr | ||||||||
| Director | 1.00 | 0.00 | Yes (X) | $1,200 | $0 | $0 | ||
| Thomas Kooiman | ||||||||
| CEO | 40.00 | 0.00 | Yes (X) | $0 | $0 | $0 | ||
| Loraine Martineau | ||||||||
| Controller | 40.00 | 0.00 | Yes (X) | $87,492 | $0 | $3,239 | ||
| Barbara Moore | ||||||||
| Physical Therapist | 40.00 | 0.00 | $102,487 | $0 | $12,085 | Yes (X) | ||
| Renae Lien | ||||||||
| Pharmacy Director | 40.00 | 0.00 | $108,833 | $0 | $0 | Yes (X) | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $306,012 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $0 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $15,324 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 2 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | 0 | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | 0 | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | 0 | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (5 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1Txt | CityContractorAddress/USAddress/CityNm | State AbbreviationContractorAddress/USAddress/StateAbbreviationCd | ZIPContractorAddress/USAddress/ZIPCd | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| Lake Region Healthcare Co | |||||
| PO Box 728 | Fergus Falls | MN | 56538 | Professional/Physician | $2,291,288 |
| West Central Internal Medicine | |||||
| PO Box 410 | Morris | MN | 56267 | Physician Services | $406,580 |
| Morris Electronics | |||||
| 511 Atlantic Avenue | Morris | MN | 56267 | IT Services | $347,075 |
| CPSI | |||||
| 6600 Wall Street | Mobile | AL | 36695 | IT Services | $309,840 |
| DMS Imaging Inc | |||||
| 26273 Network Place | Chicago | IL | 606731262 | Radiology Services | $269,697 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 12 | CntrctRcvdGreaterThan100KCnt |
| Related Organizations | $570,384 | RelatedOrganizationsAmt |
| All Other Contributions | $206,736 | AllOtherContributionsAmt |
| Total Contributions | $777,120 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (3 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| Net Patient Service Rev. | 622110 | $16,752,502 | $16,752,502 |
| Other Revenue | 900099 | $180,759 | $180,759 |
| Rural Alliance Investment | 900099 | $7,972 | $7,972 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $16,941,233 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $103,474 | TotalRevenueColumnAmt |
| Exclusion | $103,474 | ExclusionAmt |
Gross Rents GrossRentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $1,200 | RealAmt |
Less Rental Expenses LessRentalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $0 | RealAmt |
Rental Income Or Loss RentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $1,200 | RealAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $1,200 | TotalRevenueColumnAmt |
| Exclusion | $1,200 | ExclusionAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | $9,370 | OtherAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | -$9,370 | OtherAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -$9,370 | TotalRevenueColumnAmt |
| Exclusion | -$9,370 | ExclusionAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $17,813,657 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $16,941,233 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $95,304 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part IX | Yes (X) | InfoInScheduleOPartIXInd |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $98,326 | TotalAmt |
| Management And General | $98,326 | ManagementAndGeneralAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $4,611,977 | TotalAmt |
| Program Services | $3,322,629 | ProgramServicesAmt |
| Management And General | $1,289,348 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $94,993 | TotalAmt |
| Program Services | $70,340 | ProgramServicesAmt |
| Management And General | $24,653 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $305,108 | TotalAmt |
| Program Services | $220,524 | ProgramServicesAmt |
| Management And General | $84,584 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $341,645 | TotalAmt |
| Program Services | $241,551 | ProgramServicesAmt |
| Management And General | $100,094 | ManagementAndGeneralAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $131,668 | TotalAmt |
| Management And General | $131,668 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $69,078 | TotalAmt |
| Management And General | $69,078 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $4,948,115 | TotalAmt |
| Program Services | $4,120,842 | ProgramServicesAmt |
| Management And General | $827,273 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $97,303 | TotalAmt |
| Management And General | $97,303 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $690,096 | TotalAmt |
| Program Services | $547,558 | ProgramServicesAmt |
| Management And General | $142,538 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $384,494 | TotalAmt |
| Program Services | $46,593 | ProgramServicesAmt |
| Management And General | $337,901 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $53,483 | TotalAmt |
| Program Services | $37,054 | ProgramServicesAmt |
| Management And General | $16,429 | ManagementAndGeneralAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $26,349 | TotalAmt |
| Program Services | $17,850 | ProgramServicesAmt |
| Management And General | $8,499 | ManagementAndGeneralAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $623,808 | TotalAmt |
| Program Services | $623,808 | ProgramServicesAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,509,164 | TotalAmt |
| Program Services | $1,509,164 | ProgramServicesAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $111,195 | TotalAmt |
| Program Services | $111,195 | ProgramServicesAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| Medical Supplies | $2,648,734 | $2,648,734 | |
| Bad Debt Expense | $237,207 | $237,207 | |
| Repairs and Maintenance | $234,410 | $211,054 | $23,356 |
| MN Health Tax | $196,152 | $196,152 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $86,592 | TotalAmt |
| Program Services | $70,025 | ProgramServicesAmt |
| Management And General | $16,567 | ManagementAndGeneralAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $17,499,897 | TotalAmt |
| Program Services | $14,232,280 | ProgramServicesAmt |
| Management And General | $3,267,617 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,592,973 | BOYAmt |
| EOY | $1,814,342 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,616,299 | BOYAmt |
| EOY | $3,461,131 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $223,748 | BOYAmt |
| EOY | $340,265 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $246,995 | BOYAmt |
| EOY | $236,670 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $28,392,066 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $3,597,378 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $20,331,305 | BOYAmt |
| EOY | $24,794,688 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,751,656 | BOYAmt |
| EOY | $2,189,784 | EOYAmt |
Investments Other Securities InvestmentsOtherSecuritiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $193,734 | BOYAmt |
| EOY | $73,073 | EOYAmt |
Intangible Assets IntangibleAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $43,025 | BOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $341,252 | BOYAmt |
| EOY | $1,023,591 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $28,340,987 | BOYAmt |
| EOY | $33,933,544 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,483,183 | BOYAmt |
| EOY | $2,049,136 | EOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $16,631,909 | BOYAmt |
| EOY | $23,575,858 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $191,760 | BOYAmt |
| EOY | $0 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $20,306,852 | BOYAmt |
| EOY | $25,624,994 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $7,573,310 | BOYAmt |
| EOY | $7,982,759 | EOYAmt |
Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $231,277 | BOYAmt |
| EOY | $96,243 | EOYAmt |
Permanently Rstr Net Assets PermanentlyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $229,548 | BOYAmt |
| EOY | $229,548 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $8,034,135 | BOYAmt |
| EOY | $8,308,550 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $28,340,987 | BOYAmt |
| EOY | $33,933,544 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | $313,760 | ReconcilationRevenueExpnssAmt |
| Net Unrlzd Gains Losses Invst | -$39,345 | NetUnrlzdGainsLossesInvstAmt |
| Other Changes In Net Assets | $0 | OtherChangesInNetAssetsAmt |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | 0 | AccountantCompileOrReviewInd |
| FS Audited | Yes (1) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Consolidated Basis Fincl Stmt | Yes (X) | ConsolidatedBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | Yes (1) | AuditCommitteeInd |
| Federal Grant Audit Required | Yes (1) | FederalGrantAuditRequiredInd |
| Federal Grant Audit Performed | Yes (1) | FederalGrantAuditPerformedInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital | Yes (X) | HospitalInd |
Schedule B IRS990ScheduleB
Contributor Information ContributorInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor | RESTRICTED | ContributorNum |
Contributor Business Name ContributorBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor US Address ContributorUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Contributions | RESTRICTED | TotalContributionsAmt |
Schedule D IRS990ScheduleD
CY Endwmt Fund CYEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $309,625 | BeginningYearBalanceAmt |
| Investment Earnings Or Losses | $5,407 | InvestmentEarningsOrLossesAmt |
| End Year Balance | $315,032 | EndYearBalanceAmt |
CY Minus1 Yr Endwmt Fund CYMinus1YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $284,404 | BeginningYearBalanceAmt |
| Investment Earnings Or Losses | $25,221 | InvestmentEarningsOrLossesAmt |
| End Year Balance | $309,625 | EndYearBalanceAmt |
CY Minus2 Yr Endwmt Fund CYMinus2YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $281,494 | BeginningYearBalanceAmt |
| Investment Earnings Or Losses | $2,910 | InvestmentEarningsOrLossesAmt |
| End Year Balance | $284,404 | EndYearBalanceAmt |
CY Minus3 Yr Endwmt Fund CYMinus3YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $267,646 | BeginningYearBalanceAmt |
| Investment Earnings Or Losses | $13,848 | InvestmentEarningsOrLossesAmt |
| End Year Balance | $281,494 | EndYearBalanceAmt |
CY Minus4 Yr Endwmt Fund CYMinus4YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $239,135 | BeginningYearBalanceAmt |
| Investment Earnings Or Losses | $28,511 | InvestmentEarningsOrLossesAmt |
| End Year Balance | $267,646 | EndYearBalanceAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Board Designated Balance EOY | 0.00000 | BoardDesignatedBalanceEOYPct |
| Prmnnt Endowment Balance EOY | 0.72870 | PrmnntEndowmentBalanceEOYPct |
| Term Endowment Balance EOY | 0.27130 | TermEndowmentBalanceEOYPct |
| Endowments Held Unrelated Org | 0 | EndowmentsHeldUnrelatedOrgInd |
| Endowments Held Related Org | 0 | EndowmentsHeldRelatedOrgInd |
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $570,277 | OtherCostOrOtherBasisAmt |
| Book Value | $570,277 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $21,517,575 | OtherCostOrOtherBasisAmt |
| Depreciation | $1,273,088 | DepreciationAmt |
| Book Value | $20,244,487 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $6,009,816 | OtherCostOrOtherBasisAmt |
| Depreciation | $2,324,290 | DepreciationAmt |
| Book Value | $3,685,526 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $294,398 | OtherCostOrOtherBasisAmt |
| Book Value | $294,398 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $24,794,688 | TotalBookValueLandBuildingsAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
| Total Rev Etc Audited Fincl Stmt | $17,519,289 | TotalRevEtcAuditedFinclStmtAmt |
| Net Unrealized Gains Invst | -$30,782 | NetUnrealizedGainsInvstAmt |
| Other Revenue | -$237,207 | OtherRevenueAmt |
| Revenue Not Reported | -$267,989 | RevenueNotReportedAmt |
| Revenue Subtotal | $17,787,278 | RevenueSubtotalAmt |
| Other Revenues Not Included | $26,379 | OtherRevenuesNotIncludedAmt |
| Revenue Not Reported Fincl Stmt | $26,379 | RevenueNotReportedFinclStmtAmt |
| Total Revenue Per Form990 | $17,813,657 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $17,262,690 | TotExpnsEtcAuditedFinclStmtAmt |
| Expenses Not Reported | $0 | ExpensesNotReportedAmt |
| Expenses Subtotal | $17,262,690 | ExpensesSubtotalAmt |
| Other Expenses Not Included | $237,207 | OtherExpensesNotIncludedAmt |
| Expenses Not Rpt Fincl Stmt | $237,207 | ExpensesNotRptFinclStmtAmt |
| Total Expenses Per Form990 | $17,499,897 | TotalExpensesPerForm990Amt |
Supplemental Information Detail SupplementalInformationDetail (5 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| 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: | Prairie Ridge Hopital and Health Services (Health Services) 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). Health Services is annually required to file a Return of Organization Exempt from Income Tax (Form 990) with the IRS. In addition, Health Services is subject to income tax on net income that is derived from business activities that are unrelated to their exempt purpose. Health Services 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. Health Services 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 financial statements. Health Services 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 Revenue in Financial Statements -237,207. |
| Part XI, Line 4b - Other Adjustments: | Contributions Included in Temp Restricted Net Assets on Financial Statement 12,409. Interest Inc Included in Temp Restricted Net Assets on Financial Statement 13,970. |
| Part XII, Line 4b - Other Adjustments: | Bad Debt Expense Included in Revenue in Financial Statements 237,207. |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Assistance Policy | Yes (1) | FinancialAssistancePolicyInd |
| Written Policy | Yes (1) | WrittenPolicyInd |
| All Hospitals Policy | Yes (X) | AllHospitalsPolicyInd |
| FPG Reference Free Care | Yes (1) | FPGReferenceFreeCareInd |
| Percent200 | Yes (X) | Percent200Ind |
| FPG Reference Discounted Care | Yes (1) | FPGReferenceDiscountedCareInd |
Discounted Care Oth Percentage DiscountedCareOthPercentageGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | Yes (X) | OtherInd |
| Discounted Care Other | 280.000000000000 | DiscountedCareOtherPct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Free Care Medically Indigent | Yes (1) | FreeCareMedicallyIndigentInd |
| Financial Assistance Budget | 0 | FinancialAssistanceBudgetInd |
| Annual Community Bnft Report | Yes (1) | AnnualCommunityBnftReportInd |
| Report Publically Available | Yes (1) | ReportPublicallyAvailableInd |
Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $29,000 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $29,000 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00170 | TotalExpensePct |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $1,958,878 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $1,434,786 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $524,092 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.03040 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $1,987,878 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $1,434,786 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $553,092 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.03210 | TotalExpensePct |
Community Health Services CommunityHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $68,780 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $14,710 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $54,070 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00310 | TotalExpensePct |
Subsidized Health Services SubsidizedHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $5,460,145 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $4,023,456 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $1,436,689 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.08320 | TotalExpensePct |
Total Other Benefits TotalOtherBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $5,528,925 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $4,038,166 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $1,490,759 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.08630 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $7,516,803 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $5,472,952 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $2,043,851 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.11840 | TotalExpensePct |
Community Support CommunitySupportGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $100 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $100 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00000 | TotalExpensePct |
Total Communtity Building Acty TotalCommuntityBuildingActyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $100 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $100 | NetCommunityBenefitExpnsAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | 0 | BadDebtExpenseReportedInd |
| Bad Debt Expense | $237,207 | BadDebtExpenseAmt |
| Bad Debt Expense Attributable | $23,958 | BadDebtExpenseAttributableAmt |
| Reimbursed By Medicare | $6,472,298 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $6,511,736 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | -$39,438 | MedicareSurplusOrShortfallAmt |
Costing Methodology Used CostingMethodologyUsedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | Yes (X) | OtherInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | Yes (1) | WrittenDebtCollectionPolicyInd |
| Financial Assistance Prvsn | Yes (1) | FinancialAssistancePrvsnInd |
| Hospital Facilities | 1 | HospitalFacilitiesCnt |
Hospital Facilities HospitalFacilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Prairie Ridge Hospital & Health Services | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1411 Highway 79 E | AddressLine1Txt |
| City | Elbow Lake | CityNm |
| State Abbreviation | MN | StateAbbreviationCd |
| ZIP | 56531 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Website Address | www.prairiehealth.org | WebsiteAddressTxt |
| State License | 00154 | StateLicenseNum |
| Licensed Hospital | Yes (X) | LicensedHospitalInd |
| General Medical And Surgical | Yes (X) | GeneralMedicalAndSurgicalInd |
| Critical Access Hospital | Yes (X) | CriticalAccessHospitalInd |
| Emergency Room24 Hrs | Yes (X) | EmergencyRoom24HrsInd |
| Other | 4 provider based clinics | OtherDesc |
Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Prairie Ridge Hospital and Health Servic | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
| First Licensed CY Or PY | 0 | FirstLicensedCYOrPYInd |
| Tax Exempt Hospital CY Or PY | 0 | TaxExemptHospitalCYOrPYInd |
| CHNA Conducted | Yes (1) | CHNAConductedInd |
| Community Definition | Yes (X) | CommunityDefinitionInd |
| Community Demographics | Yes (X) | CommunityDemographicsInd |
| Existing Resources | Yes (X) | ExistingResourcesInd |
| How Data Obtained | Yes (X) | HowDataObtainedInd |
| Community Health Needs | Yes (X) | CommunityHealthNeedsInd |
| Other Health Issues | Yes (X) | OtherHealthIssuesInd |
| Community Hlth Needs Id Process | Yes (X) | CommunityHlthNeedsIdProcessInd |
| Consulting Process | Yes (X) | ConsultingProcessInd |
| Information Gaps | Yes (X) | InformationGapsInd |
| CHNA Conducted | 13 | CHNAConductedYr |
| Take Into Account Others Input | Yes (1) | TakeIntoAccountOthersInputInd |
| CHNA Conducted With Other Fclts | 0 | CHNAConductedWithOtherFcltsInd |
| CHNA Conducted With Non Fclts | 0 | CHNAConductedWithNonFcltsInd |
| CHNA Report Widely Available | Yes (1) | CHNAReportWidelyAvailableInd |
| Rpt Available On Own Website | Yes (X) | RptAvailableOnOwnWebsiteInd |
| Own Website URL | http://www.prairiehealth.org/index.asp?Type=B_BASIC&SEC={822070A2-F53E-4FC1 | OwnWebsiteURLTxt |
| Paper Copy Public Inspection | Yes (X) | PaperCopyPublicInspectionInd |
| Implementation Strategy Adopt | Yes (1) | ImplementationStrategyAdoptInd |
| Implementation Strategy Adpt | 13 | ImplementationStrategyAdptYr |
| Strategy Posted Website | Yes (1) | StrategyPostedWebsiteInd |
| Strategy Website URL | http://www.prairiehealth.org/index.asp?Type=B_BASIC&SEC={822070A2-F53E-4FC1 | StrategyWebsiteURLTxt |
| Strategy Attached | 0 | StrategyAttachedInd |
| Organization Incur Excise Tax | 0 | OrganizationIncurExciseTaxInd |
| Elig Criteria Explained | Yes (1) | EligCriteriaExplainedInd |
| FPG Family Incm Lmt Free Dscnt | Yes (X) | FPGFamilyIncmLmtFreeDscntInd |
| FPG Family Incm Lmt Free Care | 200.000000000000 | FPGFamilyIncmLmtFreeCarePct |
| FPG Family Incm Lmt Dscnt Care | 280.000000000000 | FPGFamilyIncmLmtDscntCarePct |
| Income Level Criteria | Yes (X) | IncomeLevelCriteriaInd |
| Asset Level Criteria | Yes (X) | AssetLevelCriteriaInd |
| Explained Basis | Yes (1) | ExplainedBasisInd |
| App Financial Asst Expln | Yes (1) | AppFinancialAsstExplnInd |
| Provided Hospital Contact | Yes (X) | ProvidedHospitalContactInd |
| Includes Publicity Measures | Yes (1) | IncludesPublicityMeasuresInd |
| FAP Available On Website | Yes (X) | FAPAvailableOnWebsiteInd |
| FAP App Available On Website | Yes (X) | FAPAppAvailableOnWebsiteInd |
| FAP Summary On Website | Yes (X) | FAPSummaryOnWebsiteInd |
| FAP Avlbl On Request No Charge | Yes (X) | FAPAvlblOnRequestNoChargeInd |
| Other Publicity | Yes (X) | OtherPublicityInd |
| FAP Actions On Nonpayment | Yes (1) | FAPActionsOnNonpaymentInd |
| Permit No Actions | Yes (X) | PermitNoActionsInd |
| Collection Activities | 0 | CollectionActivitiesInd |
| FAP Notified All Patients | Yes (X) | FAPNotifiedAllPatientsInd |
| Nondis Emergency Care Policy | Yes (1) | NondisEmergencyCarePolicyInd |
| Lowest Negotiated Rates | Yes (X) | LowestNegotiatedRatesInd |
| Amounts Generally Billed | 0 | AmountsGenerallyBilledInd |
| Gross Charges | 0 | GrossChargesInd |
Supplemental Information SupplementalInformationGrp (7 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| 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 intranet in order to get outside feedback. |
| Prairie Ridge Hospital and Health Service | Part V, Section B, Line 11: Prairie Ridge will not address Mental Health Services in the community due to lack of resources and funding.The following needs were identified and addressed.Elderly Health Services: Prairie Ridge conducted a market analysis study in 2014.Preventative Care Services: Prairie Ridge opened a new fitness center with 24 hour access in 2015.More Access to Care: Prairie Ridge opened its new facility in May 2014 and has provided additional services identified in the CHNA. |
| 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. |
| Part V, Section B, Line 16 | Financial Assistance Policy Website Availability |
| Prairie Ridge Hospital and Health Servic Part V, Section B, line 16a website: | http://www.prairiehealth.org/index.asp?Type=B_BASIC&SEC={F47F86EC-5AEE-4255 |
| Prairie Ridge Hospital and Health Servic Part V, Section B, line 16b website: | http://www.prairiehealth.org/index.asp?Type=B_BASIC&SEC={F47F86EC-5AEE-4255 |
| Prairie Ridge Hospital and Health Servic Part V, Section B, line 16c website: | http://www.prairiehealth.org/index.asp?Type=B_BASIC&SEC={F47F86EC-5AEE-4255 |
Supplemental Information Detail SupplementalInformationDetail (15 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| 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. |
| 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 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 $237,207. |
| Part II, Community Building Activities: | Donation given to community to help support events throughout the year. |
| 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 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 9-10 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 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. |
| Part VI, Line 2: | 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 2014, the population for Grant County was estimated to be 5,956. Approximately 23.1% of the population is age 65 or older. The average per capita income is $26,665 and approximately 10.1% 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. Those funds are donated back to the school athletic departments.Wellness Center - The Wellness Center in Elbow Lake is free to all diabetics. In addition, students and auxiliary members can utilize the Wellness Center at a reduced rate. Hardship cases are determined on a case to case basis.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 |
Schedule L IRS990ScheduleL
Bus Tr Involve Interested Prsn BusTrInvolveInterestedPrsnGrp
Name Of Interested NameOfInterested
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Morris Electronics Inc | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Relationship Description | Board Member Shawn Larsen is the President of Morris Electronics Inc. | RelationshipDescriptionTxt |
| Transaction | $347,075 | TransactionAmt |
| Transaction | IT Services | TransactionDesc |
| Sharing Of Revenues | 0 | SharingOfRevenuesInd |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (8 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Form 990, Part VI, Section A, line 2 | Tom Kooiman, Dr. David Bjork, John Peterson, and Gene Wenstrom all have a business relationship. |
| Form 990, Part VI, Section A, line 3 | Thomas Kooiman is paid by Lake Region HealthCare for his services as the CEO in 2014. Board members Dr. Bjork and John Peterson were both employed by Lake Region HealthCare as well. Dr. Bjork and John Peterson are compensated for their services as board members at $100 per month. Thomas Kooiman's Compensation from Lake Region Healthcare: Reportable Compensation - $165,647 Other Compensation - $15,873 The filing organization paid Lake Region HealthCare $104,489 for contracted CMO services provided by Dr. Bjork. |
| 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 Controller and CEO, 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 was determined by an unrelated management company. The Controller position was determined by the CEO based on comparability data provided by the Medi-Sota survey. This process last took place in 2014 for the Controller. |
| 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 IX, line 11g | Consulting Services: Program service expenses 16,769. Management and general expenses 117,447. Fundraising expenses 0. Total expenses 134,216. Physician Fees: Program service expenses 2,311,604. Management and general expenses 0. Fundraising expenses 0. Total expenses 2,311,604. Purchased Services: Program service expenses 1,342,032. Management and general expenses 670,133. Fundraising expenses 0. Total expenses 2,012,165. Miscellaneous: Program service expenses 450,437. Management and general expenses 39,693. Fundraising expenses 0. Total expenses 490,130. |
Schedule R IRS990ScheduleR
Id Disregarded Entities IdDisregardedEntitiesGrp
Disregarded Entity Name DisregardedEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Pharm Care LLC | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1411 Highway 79 E | AddressLine1Txt |
| City | Elbow Lake | CityNm |
| State Abbreviation | MN | StateAbbreviationCd |
| ZIP | 56531 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 411763968 | EIN |
| Primary Activities | Retail Pharmacy | PrimaryActivitiesTxt |
| Legal Domicile State | MN | LegalDomicileStateCd |
| Total Income | $0 | TotalIncomeAmt |
| End Of Year Assets | $0 | EndOfYearAssetsAmt |
Direct Controlling Entity Name DirectControllingEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Prairie Ridge Hospital and Health Services Inc | BusinessNameLine1Txt |
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp
Disregarded Entity Name DisregardedEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Prairie Ridge Foundation Inc | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1411 Highway 79 E | AddressLine1Txt |
| City | Elbow Lake | CityNm |
| State Abbreviation | MN | StateAbbreviationCd |
| ZIP | 56531 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 455092280 | EIN |
| Primary Activities | Supporting Organization | PrimaryActivitiesTxt |
| Legal Domicile State | MN | LegalDomicileStateCd |
| Exempt Code Section | 501(c)(3) | ExemptCodeSectionTxt |
| Public Charity Status | Line 11a, I | PublicCharityStatusTxt |
Direct Controlling Entity Name DirectControllingEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Prairie Ridge Hospital and Health Services Inc | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Controlled Organization | Yes (1) | ControlledOrganizationInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | 0 | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | 0 | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | Yes (1) | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | 0 | LoansOrGuaranteesFromOthOrgInd |
| Div Related Organization | 0 | DivRelatedOrganizationInd |
| Asset Sale To Other Org | 0 | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | 0 | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | 0 | AssetExchangeInd |
| Rental Of Facilities To Oth Org | 0 | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | 0 | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | 0 | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | 0 | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | 0 | SharingOfFacilitiesInd |
| Paid Employees Sharing | Yes (1) | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | 0 | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | 0 | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | 0 | TransferToOtherOrgInd |
| Transfer From Other Org | 0 | TransferFromOtherOrgInd |
Transactions Related Org TransactionsRelatedOrgGrp
Other Organization Name OtherOrganizationName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Prairie Ridge Foundation Inc | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Transaction Type | C | TransactionTypeTxt |
| Involved | $570,384 | InvolvedAmt |
| Method Of Amount Determination | Accrual | MethodOfAmountDeterminationTxt |