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Schedule I
(Form 990)
Department of the Treasury
Internal Revenue Service
Grants and Other Assistance to Organizations,
Governments and Individuals in the United States
Complete if the organization answered "Yes," on Form 990, Part IV, line 21 or 22.
Graphic Arrow Attach to Form 990.
Graphic Arrow Go to www.irs.gov/Form990 for the latest information.
OMB No. 1545-0047
2021
Open to Public
Inspection
Name of the organization
PRAIRIE LAKES HEALTH CARE SYSTEM INC
 
Employer identification number
46-0391067
Part I
General Information on Grants and Assistance
1
Does the organization maintain records to substantiate the amount of the grants or assistance, the grantees' eligibility for the grants or assistance, and
the selection criteria used to award the grants or assistance? ........................
2
Describe in Part IV the organization's procedures for monitoring the use of grant funds in the United States.
Part II
Grants and Other Assistance to Domestic Organizations and Domestic Governments. Complete if the organization answered "Yes" on Form 990, Part IV, line 21, for any recipient
that received more than $5,000. Part II can be duplicated if additional space is needed.
(a) Name and address of organization
or government		 (b) EIN (c) IRC section
(if applicable)		 (d) Amount of cash grant (e) Amount of non-cash
assistance		 (f) Method of valuation
(book, FMV, appraisal,
other)		 (g) Description of
noncash assistance		 (h) Purpose of grant
or assistance
(1) WATERTOWN AREA UNITED WAY
PO BOX 283
WATERTOWN,SD57201 		46-0359557 501(C)(3) 35,000 0     SUPPORT OF NEW BUSINESS DEVELOPMENT
(2) LAKE AREA TECHNICAL INSTITUTE FOUNDATION
PO BOX 730
WATERTOWN,SD57201 		36-3860861 501(C)(3) 18,130 0     SCHOLARSHIPS
(3) HUMAN SERVICE AGENCY
PO BOX 1030
WATERTOWN,SD57201 		46-0275247 501(C)(3) 30,000 0     DETOX UNIT SUPPORT
(4) WATERTOWN DEVELOPMENT CORP
PO BOX 1267
WATERTOWN,SD57201 		46-6012194 501(C)(6) 80,000 0     SUPPORT NEW BUSINESS DEVELOPMENT
(5) JOY RANCH
16633 448TH AVENUE
FLORENCE,SD57235 		87-1202375 501(C)(3) 4,000,000 0     SUPPORT FOR FAMILY PLANNING CENTER
(6) BOYS & GIRLS CLUB OF WATERTOWN
PO BOX 833
WATERTOWN,SD57201 		46-0311845 501(C)(3) 6,000 0     SUPPORT
(7) CASTLEWOOD COMMUNITY FOUNDATION
PO BOX 263
CASTLEWOOD,SD57223 		82-2466393 501(C)(3) 25,000 0     SUPPORT
(8) CODINGTON COUNTY HISTORICAL SOCIETY
27 1ST AVENUE SOUTHEAST
WATERTOWN,SD57201 		46-0335602 501(C)(3) 10,000 0     SUPPORT
(9) SOUTHEAST TECHNICAL COLLEGE
201 EAST 38TH STREET
SIOUX FALLS,SD57105 		46-6002586 501(C)(3) 24,000 0     SUPPORT
2
Enter total number of section 501(c)(3) and government organizations listed in the line 1 table ................. Graphic Arrow
 
3
Enter total number of other organizations listed in the line 1 table ........................ . Graphic Arrow
 
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50055P
Schedule I (Form 990) 2021
Page 2

Schedule I (Form 990) 2021
Page 2
Part III
Grants and Other Assistance to Domestic Individuals. Complete if the organization answered "Yes" on Form 990, Part IV, line 22.
Part III can be duplicated if additional space is needed.
(a) Type of grant or assistance (b) Number of
recipients		 (c) Amount of
cash grant		 (d) Amount of
noncash assistance		 (e) Method of valuation (book,
FMV, appraisal, other)		 (f) Description of noncash assistance
(1)
(2)
(3)
(4)
(5)
(6)
(7)
Part IV
Supplemental Information. Provide the information required in Part I, line 2; Part III, column (b); and any other additional information.
Return Reference Explanation
PART I, LINE 2: FUNDS ARE GRANTED BASED ON ORGANIZATIONS AND INTERNAL REQUESTS. GRANT REQUESTS ARE REVIEWED AND APPROVED BY ADMINISTRATIVE LEADERSHIP TO BE USED FOR THE PURPOSES REQUESTED BY THE ORGANIZATION. FURTHER MONITORING IS NOT DONE ON A REGULAR BASIS.
Schedule I (Form 990) 2021



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