Community Benefit Insight - Tax-exempt hospital

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Prairie Lakes Health Care System Inc

Prairie Lakes Health Care Center

401 9th Ave Nw
Watertown, SD 57201

Bed count	81	Medicare provider number	430005	Member of the Council of Teaching Hospitals	NO	Children's hospital	NO

EIN: 460391067

Display data for year:

Community Benefit Spending- 2021
(as % of functional expenses, which all tax-exempt organizations report on Form 990 Schedule H)

15.8%

Spending by Community Benefit Category- 2021
(as % of total functional expenses)

* = CBI denoted preventative categories

Community Benefit Spending Compared to Functional Expenses, 2010-2021

Additional data

Community Benefit Expenditures: 2021

All tax-exempt organizations file a Form 990 with the IRS for every tax year. If the tax-exempt organization operates one or more hospital facilities during the tax year, the organization must attach a Schedule H to Form 990. On Part I of Schedule H, the organization records the expenditures it made during the tax year for various types of community benefits; 9 types are shown on this web tool. By default, this web tool presents community benefit expenditures as a percentage of the organization’s functional expenses, which it reports on Form 990, Part IX, Line 25, Column A. (The more commonly heard term, ‘total operating expenses’, which organizations report to CMS, is generally about 90% of the ‘functional expenses’). The user may change the default to see the dollar expenditures.
Amount spent in the following IRS community benefit categories:

Financial Assistance at cost as % of operating expenses	$ 3,539,315 2.82 %
Medicaid as % of operating expenses	$ 8,235,032 6.56 %
Costs of other means-tested government programs as % of operating expenses	$ 0 0 %
Health professions education as % of operating expenses	$ 0 0 %
Subsidized health services as % of operating expenses	$ 8,062,041 6.42 %
Research as % of operating expenses	$ 0 0 %
Community health improvement services and community benefit operations* as % of operating expenses Note: these two community benefit categories are reported together on the Schedule H, part I, line 7e.	$ 7,888 0.01 %
Cash and in-kind contributions for community benefit* as % of operating expenses	$ 0 0 %
Community building* as % of operating expenses	$ 7,888 0.01 %

* = CBI denoted preventative categories

Community building activities details:

Did tax-exempt hospital report community building activities?	YES
Number of activities or programs (optional)	0
Physical improvements and housing	0
Economic development	0
Community support	0
Environmental improvements	0
Leadership development and training for community members	0
Coalition building	0
Community health improvement advocacy	0
Workforce development	0
Other	0
Persons served (optional)	0
Physical improvements and housing	0
Economic development	0
Community support	0
Environmental improvements	0
Leadership development and training for community members	0
Coalition building	0
Community health improvement advocacy	0
Workforce development	0
Other	0
Community building expense as % of operating expenses	$ 7,888 0.01 %
Physical improvements and housing as % of community building expenses	$ 0 0 %
Economic development as % of community building expenses	$ 0 0 %
Community support as % of community building expenses	$ 0 0 %
Environmental improvements as % of community building expenses	$ 0 0 %
Leadership development and training for community members as % of community building expenses	$ 0 0 %
Coalition building as % of community building expenses	$ 7,888 100 %
Community health improvement advocacy as % of community building expenses	$ 0 0 %
Workforce development as % of community building expenses	$ 0 0 %
Other as % of community building expenses	$ 0 0 %
Direct offsetting revenue	$ 0
Physical improvements and housing	$ 0
Economic development	$ 0
Community support	$ 0
Environmental improvements	$ 0
Leadership development and training for community members	$ 0
Coalition building	$ 0
Community health improvement advocacy	$ 0
Workforce development	$ 0
Other	$ 0

Other Useful Tax-exempt Hospital Information: 2021

In addition to community benefit and community building expenditures, the Schedule H worksheet includes sections on what percentage of bad debt can be attributable to patients eligible for financial assistance, and questions on the tax-exempt hospital's debt collection policy. When searching a specific tax-exempt hospital in this web tool, Section II provides information about bad debt and the financial assistance policy, and whether the state in which the tax-exempt hospital resides has expanded Medicaid coverage under the federal ACA.

Of the tax-exempt hospital’s overall operating expenses, amount reported as bad debt as % of operating expenses	$ 4,565,776 3.64 %
Is the tax-exempt hospital considered a "sole community hospital" under the Medicare program?	NO

Information about the tax-exempt hospital's Financial Assistance Policy and Debt Collection Policy
The Financial Assistance Policy section of Schedule H has changed over the years. The questions listed below reflect the questions on the 2009-2011 Schedule H forms and the answers tax-exempt hospitals provided for those years. The Financial Assistance Policy requirements were changed under the ACA. In the future, as the Community Benefit Insight web site is populated with 2022 data and subsequent years, the web tool will also be updated to reflect the new wording and requirements. In the meantime, if you have any questions about this section, we encourage you to contact your tax-exempt hospital directly.

Does the organization have a written financial assistance (charity care) policy?	YES
Did the tax-exempt hospital rely upon Federal Poverty Guidelines (FPG) to determine when to provide free or discounted care for patients?	YES
Amount of the tax-exempt hospital’s bad debt (at cost) attributed to patients eligible under the organization’s financial assistance (charity care) policy as % of operating expenses	$ 0 0 %

Did the tax-exempt hospital, or an authorized third party, take any of the following collection activities before determining whether the patient was eligible for financial assistance:
Under the ACA, states have the choice to expand Medicaid eligibility for their residents up to 138% of the federal poverty guidelines. The Medicaid expansion provision of the ACA did not go into effect until January 2014, so data in this web tool will not reflect each state's current Medicaid eligibility threshold. For up to date information, please visit the Terms and Glossary under the Resources tab.
The federal poverty guidelines (FPG) are set by the government and used to determine eligibility for many federal financial assistance programs. Tax-exempt hospitals often use FPG guidelines in their Financial Assistance policies to determine which patients will qualify for free or discounted care.
In addition to the federal requirements, some states have laws stipulating community benefit requirements as a result of tax-exemption. The laws vary from state to state and may require the tax-exempt hospitals to submit community benefit reports. Data on this web tool captures whether or not a state had a mandatory community benefit reporting law as of 2011. For more information, please see Community Benefit State Law Profiles Comparison at The Hilltop Institute.

Community Health Needs Assessment Activities: 2021

The ACA requires all 501(c)(3) tax-exempt hospitals to conduct a Community Health Needs Assessment (CHNA) every three years, starting with the hospital's tax year beginning after March 23, 2012. The 2011 Schedule H included an optional section of questions on the CHNA process. This web tool includes responses for those hospitals voluntary reporting this information. The web tool will be updated to reflect changes in these questions on the 2012 and subsequent Schedule H forms.

Did the tax-exempt hospital report that they had conducted a CHNA?	YES
Did the CHNA define the community served by the tax-exempt hospital?	YES
Did the CHNA consider input from individuals that represent the broad interests of the community served by the tax-exempt hospital?	YES
Did the tax-exempt hospital make the CHNA widely available (i.e. post online)?	YES
Did the tax-exempt hospital adopt an implementation strategy to address the community needs identified by the CHNA?	YES

Supplemental Information: 2021

This section presents qualitative information submitted by the hospital, verbatim from the 990H record.

Statement of Program Service Accomplishments
Description of the organization's program service accomplishments for each of its three largest program services, as measured by expenses. Section 501(c)(3) and 501(c)(4) organizations are required to report the amount of grants and allocations to others, the total expenses, and revenue, if any, for each program service reported.

4A (Expenses $ 107383940 including grants of $ 4265261) (Revenue $ 140443568)
PRAIRIE LAKES HEALTH CARE SYSTEM SERVES TEN COUNTIES IN NORTHEASTERN SOUTH DAKOTA AND WESTERN MINNESOTA AS A RURAL, REGIONAL MEDICAL CENTER. IT IS COMMITTED TO PROVIDING ACCESSIBLE, HIGH QUALITY, COST-EFFECTIVE HEALTHCARE SERVICES AS IT MANAGES EFFECTIVELY THE TRANSITION TO NEW PAYMENT AND CARE DELIVERY MODELS. 28 SPECIALTY PHYSICIANS HAVE BEEN RECRUITED OVER THE PAST DECADE TO BUILD NEW SERVICES AND BETTER SERVE THE NEEDS OF THE REGION.

Facility Information

Schedule H (Form 990) Section C. Supplemental Information for Part V, Section B.

PRAIRIE LAKES HEALTH CARE SYSTEM
"PART V, SECTION B, LINE 5: PLHS UTILIZED COUNTY HEALTH RANKINGS TO SEE HEALTH OUTCOMES AND HEALTH FACTORS FOR BOTH THE PRIMARY AND SECONDARY SERVICE AREA. THE COUNTY HEALTH RANKINGS SHOWED DIFFERENCES BETWEEN THE COUNTY'S VALUES AND STATE OR NATIONAL AVERAGE. THESE AREAS TO EXPLORE WERE COMPARED WITH DATA FROM THE COMMUNITY. IN ORDER TO ADDRESS THE NEEDS OF THE ENTIRE ""COMMUNITY,"" STAKEHOLDERS INCLUDED INDIVIDUALS FROM OUTSIDE THE PRIMARY SERVICE AREA OF PLHS. INPUT WAS OBTAINED THROUGH TWO FOCUS GROUP SESSIONS. SESSIONS WERE HELD OVER 2 DAYS AND APPROXIMATELY 25 ORGANIZATIONS WERE REPRESENTED. IN ADDITION TO FOCUS GROUPS THE HUMAN SERVICE AGENCY IN COLLABORATION WITH A GRADUATE STUDENT PROJECT PERFORMED A COMMUNITY SURVEY FOR RESEARCH AND ANALYSIS IN SPRING OF 2021. THE CODINGTON COUNTY WELFARE COMMISSIONER'S ASSET MAP WAS VIEWED TO ESTABLISH SYSTEMS OF CARE TO IMPROVE COMMUNITY SERVICES. THE DATA FROM FOCUS GROUPS, THE COMMUNITY SURVEY, AND ASSET MAP WERE COMPLIED. ANY AREAS THAT OVERLAPPED BETWEEN THE COUNTY HEATH RANKINGS AND THE FOCUS GROUPS WAS REVIEWED BY THE CHNA WORK GROUP AND PRIORITIZED THE NEEDS IDENTIFIED."

PRAIRIE LAKES HEALTH CARE SYSTEM
PART V, SECTION B, LINE 7D: THE ORGANIZATION'S COMMUNITY HEALTH NEEDS ASSESSMENT REPORT AND IMPLEMENTATION STRATEGY ARE AVAILABLE ONLINE AT HTTPS://WWW.PRAIRIELAKES.COM/COMMUNITY/COMMUNITY-BENEFIT-513.HTML.

PRAIRIE LAKES HEALTH CARE SYSTEM
PART V, SECTION B, LINE 11: 1. MENTAL AND BEHAVIORAL HEALTH-PLHS PROVIDES STAFF MEMBERS WITH RESOURCES THAT CAN BE UTILIZED SUCH AS ASSISTANCE PROGRAMS FOR MENTAL HEALTH SERVICES AND A RESPITE LOUNGE-PLHS COLLABORATES WITH THE FOLLOWING ORGANIZATIONS WATERTOWN BOYS AND GIRLS CLUB TO SUPPORT THEIR EFFORTS, H.S.A TO SUPPORT THEIR SUICIDE PREVENTION SERVICES AND ANNUAL AWARENESS WALK. SERENITY HILLS- A FACILITY AND SAFE HOUSE FOR THOSE SUFFERING FROM MENTAL ILLNESS COMMUNITY TRANSIT WATERTOWN/SISSETON-TRANSPORT INDIVIDUALS TO MENTAL HEALTH APPOINTMENTS.2. HEALTH EDUCATION, LITERACY, AND PREVENTION-VIDEOS AND EDUCATION ARE DISPLAYED ON THE WEBSITE FOR EASE OF ACCESS TO EDUCATE THE PUBLIC. IN ADDITION, MONTHLY PRIORITY HEALTH ARTICLES ARE IN THE LOCAL PAPER, POSTED TO THE WEBSITE AND SHARED ON SOCIAL MEDIA. PLHS ALSO DOES EDUCATION RADIO INTERVIEWS ON LOCAL STATIONS AND OFFERS LARGE IN PERSON AND ONLINE EVENTS.HEALTH SCREENINGS ARE BEING PROMOTED TO ASSIST WITH PREVENTION.3. SMOKING/DRUGS/ALHOHOL-VIDEOS AND EDUCATION ARE DISPLAYED ON THE WEBSITE WHICH FOCUS ON DISEASES CAUSED BY USING THE SUBSTANCES. A FULL-TIME MIDLEVEL WAS ADDED TO WORK ALONGSIDE A FULL-TIME PULMONOLOGIST TO EASE ACCESS BARRIERS. PLHS WORKING TO START A SERVICE LINE FOR PAIN THERAPY. AS WELL AS OFFER FREE COMMUNITY PAIN EDUCATION CLASSES.-PLHS COLLABORATES WITH THE FOLLOWING ORGANIZATIONS BY PROVIDING FINANCIAL SUPPORTSERENITY HILLSDASHWATERTOWN HEALTHY YOUTHWATERTOWN AREA UNITED WAYBOYS AND GIRLS CLUB OF WATERTOWNSIGNIFICANT NEEDS TO ASSESSEDMANY ISSUES EMERGED THAT WERE BEYOND THE SCOPE OR CONTROL OF PLHS. ISSUES SUCH AS AFFORDABILITY OF CARE/UNDERINSURED, ECONOMY & WORKFORCE SHORTAGE, UNEMPLOYMENT, SEX EDUCATION/TEEN PREGNANCY, AND PRIMARY CARE PHYSICIANS WILL BE DEFERRED TO THE APPROPRIATE COMMUNITY ORGANIZATIONS.

PRAIRIE LAKES HEALTH CARE SYSTEM
PART V, SECTION B, LINE 16J: HTTPS://WWW.PRAIRIELAKES.COM/BILLING-AND-INSURANCE/FINANCIAL-ASSISTANCE-PROGRAM-510.HTML

Supplemental Information

Schedule H (Form 990) Part VI

PART I, LINE 3C:
IN ADDITION TO INCOME BASED CRITERIA FOR DETERMINING THE AMOUNT OF FINANCIAL ASSISTANCE SERVICES FOR WHICH A PATIENT IS ELIGIBLE AT THE TIME OF SERVICE OR DURING THE BILLING-AND-COLLECTION PROCESS, PLHS USES AN ASSET TEST. ASSET EXCLUSIONS THAT ARE CONSIDERED IN QUALIFYING FOR FINANCIAL ASSISTANCE ARE: (A) EQUITY IN PRIMARY RESIDENCE UP TO $15,000(B) EQUITY IN AUTOMOBILE UP TO $5,000(C) 70% OF VALUE OF ASSETS IN RETIRMENT ACCOUNTS(D) ASSETS IN CHECKING/SAVINGS/ETC. UP TO $15,000(E) OTHER ASSETS USED FOR INCOME PRODUCING PURPOSES.

PART I, LINE 7:
THE COSTS OF THE SUBSIDIZED SERVICES ARE BASED ON DIRECT COST PROVIDED BY THE DEPARTMENTS FOR THE SERVICES.

PART I, LINE 7G:
THE SUBSIDIZED HEALTH SERVICES INCLUDED IN SCHEDULE H, PART I, LINE 7G RELATE TO THE EMERGENCY ROOM, CARDIOLOGY CLINIC, ONCOLOGY CLINIC, NEPHROLOGY CLINIC, UROLOGY CLINIC, PULMONOLOGY CLINIC, AND ENT CLINIC.

PART I, LN 7 COL(F):
$4,565,776 OF BAD DEBT EXPENSE WAS ELIMINATED WHEN CALCULATING PART I, LINE 7, COLUMN F.

PART II, COMMUNITY BUILDING ACTIVITIES:
THE ORGANIZATION SUPPORTS COMMUNITY BUILDING ACTIVITIES THROUGH DONATIONS TO COMMUNITY PROJECTS SUCH AS THE WATERTOWN COMMUNITY FOUNDATION WHICH WORKS TO BRING NEW BUSINESSES TO WATERTOWN, JOY RANCH WHICH PROVIDES CAMP EXPERIENCE TO DISABLED CHILDREN, LAKE AREA TECHNICAL COLLEGE WHICH PROVIDES EDUCATION AND TRAINING FOR HEALTH PROFESSIONALS, THE BOYS AND GIRLS CLUB WHICH PROVIDES RESOURCES FOR COMMUNITY YOUTH.

PART III, LINE 2:
IN EVALUATING THE COLLECTABILITY OF PATIENT ACCOUNTS RECEIVABLE, THE HEALTH SYSTEM ANALYZES ITS PAST HISTORY AND IDENTIFIES TRENDS FOR EACH OF ITS MAJOR PAYER SOURCES OF REVENUE TO ESTIMATE THE APPROPRIATE ALLOWANCE FOR DOUBTFUL ACCOUNTS AND PROVISION FOR BAD DEBTS. MANAGEMENT REGULARLY REVIEWS DATA ABOUT THESE MAJOR PAYER SOURCES OF REVENUE IN EVALUATING THE SUFFICIENCY OF THE ALLOWANCE FOR DOUBTFUL ACCOUNTS. FOR RECEIVABLES ASSOCIATED WITH SERVICES PROVIDED TO PATIENTS WHO HAVE THIRD-PARTY COVERAGE, THE HEALTH SYSTEM ANALYZES CONTRACTUALLY DUE AMOUNTS AND PROVIDES AN ALLOWANCE FOR DOUBTFUL ACCOUNTS AND A PROVISION FOR BAD DEBTS, IF NECESSARY. FOR RECEIVABLES ASSOCIATED WITH SELF-PAY PATIENTS (WHICH INCLUDES BOTH PATIENTS WITHOUT INSURANCE AND PATIENTS WITH DEDUCTIBLE AND COPAYMENT BALANCES DUE FOR WHICH THIRD-PARTY COVERAGE EXISTS FOR PART OF THE BILL), THE HEALTH SYSTEM RECORDS A SIGNIFICANT PROVISION FOR BAD DEBTS IN THE PERIOD OF SERVICE ON THE BASIS OF ITS PAST EXPERIENCE, WHICH INDICATES THAT MANY PATIENTS ARE UNABLE OR UNWILLING TO PAY THE PORTION OF THEIR BILL FOR WHICH THEY ARE FINANCIALLY RESPONSIBLE.

PART III, LINE 3:
THE ORGANIZATION DOES NOT HAVE A WAY TO IDENTIFY THE NUMBER OF PEOPLE WHO WOULD QUALIFY FOR FINANCIAL ASSISTANCE SO WE HAVE REPORTED $0 IN PART III, LINE 3.

PART III, LINE 4:
"SEE THE ""PATIENT ACCOUNTS RECEIVABLE"" PARAGRAPH ON PAGE 9 OF THE AUDITED FINANCIAL STATEMENTS."

PART III, LINE 8:
THERE WAS NO SHORTFALL CALCULATED IN PART III, LINE 7.THE MEDICARE ALLOWABLE COSTS INCLUDED IN PART III, LINE 6 WAS DERIVED USING THE 2022 FILED MEDICARE COST REPORT.

PART III, LINE 9B:
BILLING STATEMENTS AND COLLECTION LETTERS WILL CONTAIN INFORMATION DIRECTING PATIENTS TO CONTACT THE HOSPITAL FOR INFORMATION ABOUT FINANCIAL ASSISTANCE OR PAYMENT PLANS IF THE PATIENTS ARE UNABLE TO PAY THE FULL OUTSTANDING ACCOUNT BALANCE BY THE DUE DATE. IF A COMPLETE ASSISTANCE APPLICATION IS RECEIVED, A DETERMINATION OF THE PATIENT'S ELIGIBILITY WILL BE DOCUMENTED APPROPRIATELY AND COMMUNICATED TO THE PATIENT IN WRITING. IF ELIGIBLE, THE HOSPITAL WILL ISSUE A BILLING STATEMENT WITH THE AMOUNT NOW OWED (ALONG WITH THE AMOUNT GENERALLY BILLED AND HOW IT WAS CALCULATED), REFUND ANY CREDIT BALANCES, AND REVERSE ANY EXTRAORDINARY COLLECTION ACTIONS. IF AN INCOMPLETE FINANCIAL ASSISTANCE APPLICATION (FAA) IS RECEIVED BY THE HOSPITAL, THE HOSPITAL WILL CEASE COLLECTION ACTIONS AND ALLOW 30 DAYS FOR THE FAA TO BE FULLY COMPLETED.

PART VI, LINE 2:
THE FACILITY CONDUCTS NEEDS ASSESSMENT SURVEYS IN THE COMMUNITY AND SURROUNDING AREA TO DETERMINE WHAT HEALTH CARE SERVICES NEED TO BE ADDRESSED.

PART VI, LINE 3:
PLHS INFORMS AND EDUCATES PATIENTS ABOUT FINANCIAL ASSISTANCE THROUGH INFORMATION PROVIDED ON THE PLHS WEBSITE. FURTHERMORE, HOSPITAL STAFF PROVIDE INFORMATION REGARDING FINANCIAL ASSISTANCE ELIGIBILITY.

PART VI, LINE 4:
PRAIRIE LAKES HEALTH CARE SYSTEM'S PRIMARY SERVICE AREA COVERS 3 COUNTIES IN SOUTH DAKOTA WITH A POPULATION OF APPROXIMATELY 38,000. IT'S SECONDARY SERVICE AREA COVERS 4 COUNTIES IN SOUTH DAKOTA AND 3 COUNTIES IN MINNESOTA WITH A POPULATION OF 49,000.

PART VI, LINE 5:
THE ORGANIZATION OFFERS HEALTH SEMINARS FREE TO COMMUNITY MEMBERS COVERING A VARIETY OF HEALTH TOPICS IN AN EFFORT TO EDUCATE PEOPLE ABOUT LEADING HEALTHY LIVES. COMMUNITY FORUMS ARE HELD TO UPDATE ATTENDEES ABOUT NEW EVENTS AND TECHNOLOGY AT THE FACILITY. THE ORGANIZATION WORKS WITH THE TECHNICAL COLLEGE AND TWO STATE UNIVERSITIES TO HELP TRAIN MEDICAL STUDENTS. THE ORGANIZATION IS DEDICATED TO IMPLEMENTING AND MAINTAINING THE MOST CURRENT TECHNOLOGY IN PROVIDING CARE.

PART VI, LINE 7, REPORTS FILED WITH STATES
SD

Operating expenses	$ 125,590,516
Total amount spent on community benefits as % of operating expenses	$ 19,844,276 15.80 %