2014-08-14T08:38:07-05:00 2013-12-31 450250958 EIDE BAILLY LLP 4310 17TH AVE S PO BOX 2545 FARGO ND 581082545 990 2013-01-01 411763968 Prairie Ridge Hospital and Health Services Inc PRAI 2186854461 1411 Highway 79 E Elbow Lake MN 56531 Thomas Kooiman CEO 2186854461 2014-08-06 1 LISA CHAFFEE CPA P00193453 7012398500 2014-08-06 2013 2015-11-30 17:44:51Z X Thomas Kooiman 1411 Highway 79 E Elbow Lake MN 56531 15539470 0 X www.prairiehealth.org X 1993 MN An acute care hospital and ambulatory outpatient facility. 6 5 177 0 0 0 46434 185511 14881593 15284226 81488 64361 1852 1408 15011367 15535506 0 0 0 0 4855720 5154671 0 0 0 8895725 9424233 13751445 14578904 1259922 956602 17588117 28340987 10543039 20306852 7045078 8034135 Serving the healthcare needs of the people. 0 0 11843144 15295566 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 $122,017 and $111,023 during the years ended December 31, 2013 and 2012. 11843144 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 0 0 0 0 0 0 0 0 1 0 0 0 0 1 1 1 0 0 0 1 31 0 1 177 1 0 0 0 0 0 0 0 0 0 0 X 6 5 1 1 0 0 0 0 0 1 0 0 0 1 1 1 1 1 1 0 0 0 MN X Loraine Martineau 2186857343 1411 Highway 79 E Elbow Lake MN 56531 Gene Wenstrom Chair 1.00 0.10 X X 1200 0 0 John Peterson Vice Chair 1.00 X X 0 0 0 Sandy Alvstad Secretary 1.00 X X 1200 0 0 Wes Moir Director 1.00 X 1200 0 0 Shawn Larsen Director 1.00 X 1200 0 0 David Bjork Director/CMO 9.00 X 1200 0 0 Thomas Kooiman CEO 40.00 X 0 0 0 Loraine Martineau Controller 40.00 X 87930 0 7001 Barbara Moore Physical Therapist 40.00 X 103099 0 11861 197029 0 18862 1 0 0 0 Lake Region Healthcare Co PO Box 728 Fergus Falls MN 56538 Professional/Physician 2677613 West Central Internal Medicine PO Box 410 Morris MN 56267 Physician Services 374166 DMS Imaging Inc 26273 Network Place Chicago IL 60673 Imaging Services 329662 Morris Electronics 511 Atlantic Avenue Morris MN 56267 IT Services 249250 Medical Arts Clinic LTD 930 1st Street NE Elbow Lake MN 56531 Physician Services 234592 12 7937 177574 185511 Net Patient Service Rev. 622110 14887526 14887526 Other Revenue 900099 406632 406632 Rural Alliance K-1 900099 -9932 -9932 15284226 68325 68325 1408 0 1408 1408 1408 3964 -3964 -3964 -3964 15535506 15284226 0 65769 X 100968 100968 4353349 3157234 1196115 91840 68555 23285 282392 208203 74189 326122 231852 94270 69769 69769 61888 61888 4422664 3787786 634878 89933 89933 583957 483561 100396 234012 47318 186694 52197 35019 17178 32106 28583 3523 137629 137629 873827 873827 80511 80511 Medical Supplies 2042005 2042005 Bad Debt Expense 253070 253070 Repairs and Maintenance 221901 201191 20710 MN Health Tax 176646 176646 92118 30154 61964 14578904 11843144 2735760 0 1552296 2592973 9545 2502643 2616299 239590 223748 187370 246995 23629794 3298489 6930465 20331305 5411049 1751656 50452 193734 107426 43025 597281 341252 17588117 28340987 2236956 3483183 8306083 16631909 0 191760 10543039 20306852 X 6724831 7573310 90699 231277 229548 229548 7045078 8034135 17588117 28340987 X 956602 22523 9932 X 0 1 X 1 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 284404 25221 309625 281494 2910 284404 267646 13848 281494 239135 28511 267646 220945 48190 30000 239135 0.74140 0.25860 0 0 283690 283690 4296150 959205 3336945 3626968 2339284 1287684 15422986 15422986 20331305 Due to Third Party Payor 191760 191760 X 15121262 -253070 -253070 15374332 161174 161174 15535506 14325834 0 14325834 253070 253070 14578904 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 -253,070. Part XI, Line 4b - Other Adjustments: Contributions in Fund Balance on Financial Statements 158,678. Interest Income Included In Fund Balance in Financial Statements 12,428. K-1 Tax Loss - Rural Health Alliance LLC -9,932. Part XII, Line 4b - Other Adjustments: Bad Debt Expense Included in Revenue in Financial Statements 253,070. 1 1 X 1 X 1 X 280.000000000000 1 0 1 1 73000 73000 0.00510 1924522 1845201 79321 0.00550 1997522 1845201 152321 0.01060 95131 26147 68984 0.00480 4793941 3572856 1221085 0.08520 4889072 3599003 1290069 0.09000 6886594 5444204 1442390 0.10060 100 100 0.00000 100 100 0 253070 31381 5328305 5345438 -17133 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 1 X X X X X X X X X 13 1 0 1 X www.prairiehealth.org. X X X X X X 0 0 1 1 200.000000000000 1 280.000000000000 1 X X X 1 1 X X 1 0 X 1 X 0 0 Prairie Ridge Hospital and Health Service Part V, Section B, Line 3: 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 6i: Prairie Ridge adopted an implementation strategy to address the community health needs identified in its Community Health Needs Assessment. The implementation strategy is posted on the website at www.prairiehealth.org. Prairie Ridge Hospital and Health Service Part V, Section B, Line 7: Prairie Ridge will not address Mental Health Services in the communit due to lack of resources and funding.The following needs were identified and will be addressed in the future, but were not addressed in 2013 due to time constraints:Elderly Health Services: Prairie Ridge will conduct a market analysis study in 2014.Preventative Care Services: Prairie Ridge will be opening a new fitness center with 24 hour access in 2014.More Access to Care: At the end of 2013 Prairie Ridge was in the final stages of building a new healthcare facility. The new facility will open in 2014 and provide additional services identified in the CHNA. Prairie Ridge Hospital and Health Service Part V, Section B, Line 14g: 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 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 $253,070. 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 nine 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 2013 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 2013, the population for Grant County was estimated to be 5,989. Approximately 23% of the population is age 65 or older. The average per capita income is $24,169 and approximately 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. PRHSS 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 Morris Electronics Inc Board Member Shawn Larsen is the President of Morris Electronics Inc. 249250 IT Services 0 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 2013. 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: Base Compensation- $170,418 Other Compensation- $360 Nontaxable Health Benefits- $1,202 The filing organization paid Lake Region HealthCare $108,973 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 2012. 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 10,509. Management and general expenses 40,272. Fundraising expenses 0. Total expenses 50,781. Physician Fees : Program service expenses 2,149,219. Management and general expenses 0. Fundraising expenses 0. Total expenses 2,149,219. Purchased Services : Program service expenses 1,174,448. Management and general expenses 569,201. Fundraising expenses 0. Total expenses 1,743,649. Miscellaneous : Program service expenses 453,610. Management and general expenses 25,405. Fundraising expenses 0. Total expenses 479,015. Form 990, Part XI, line 9: K-1 Tax Loss - Rural Health Alliance LLC 9,932. 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 11a, I Prairie Ridge Hospital and Health Services Inc 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0