TY 2021 Form 990 Schedule O

efile Public Visual Render ObjectId: 202301089349301355 - Submission: 2023-04-18 TIN: 46-0391067

SCHEDULE O
(Form 990)

Department of the Treasury
Internal Revenue Service

Supplemental Information to Form 990 or 990-EZ

Complete to provide information for responses to specific questions on
Form 990 or 990-EZ or to provide any additional information.
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Attach to Form 990 or 990-EZ.
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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

Return Reference	Explanation
FORM 990, PART VI, SECTION A, LINE 1A	THE EXECUTIVE COMMITTEE SHALL BE COMPRISED OF THE OFFICERS OF THE CORPORATION. EXCEPT AS MAY BE LIMITED BY THE BOARD, THE EXECUTIVE COMMITTEE SHALL HAVE AND EXERCISE THE AUTHORITY OF THE BOARD IN THE MANAGEMENT OF THE BUSINESS OF THE CORPORATION. THE EXECUTIVE COMMITTEE SHALL ACT IN THE INTERVALS BETWEEN MEETINGS OF THE BOARD AND SHALL AT ALL TIMES BE SUBJECT TO THE CONTROL AND DIRECTION OF THE BOARD. THE EXECUTIVE COMMITTEE SHALL ALSO SERVE AS THE CORPORATION'S COMPENSATION COMMITTEE, UNLESS IT OR THE BOARD DELEGATES THOSE RESPONSIBILITIES TO ANOTHER COMMITTEE OF THE BOARD. THE EXECUTIVE COMMITTEE SHALL NOT USURP THE FUNCTIONS OF THE OTHER STANDING COMMITTEES, ALTHOUGH IT WILL COORDINATE PROJECTS, TASKS AND COMMUNICATIONS AMONG SUCH COMMITTEES. A MAJORITY OF THE EXECUTIVE COMMITTEE SHALL CONSTITUTE A QUORUM FOR THE TRANSACTION OF ANY BUSINESS.
FORM 990, PART VI, SECTION B, LINE 11B	EXECUTIVE MANAGEMENT REVIEWS THE FORM 990 IN DETAIL. THE FORM 990 IS PRESENTED TO THE FINANCE COMMITTEE CHAIR FOR FINAL REVIEW PRIOR TO FILING WITH THE IRS.
FORM 990, PART VI, SECTION B, LINE 12C	A CONFLICT OF INTEREST STATEMENT IS SIGNED BY ALL BOARD MEMBERS ANNUALLY. THIS STATEMENT DISCLOSES ANY AREAS THAT MAY POTENTIALLY PRESENT A CONFLICT OF INTEREST WITH THEMSELVES OR FAMILY MEMBERS. THE CONFLICT OF INTEREST POLICY IS MONITORED BY THE CEO AND THE BOARD. MEMBERS WILL EXCUSE THEMSELVES DURING BOARD MEETING FROM ANY DISCUSSION OR VOTING ON AN ISSUE WHERE THERE MAY BE A CONFLICT OF INTEREST.
FORM 990, PART VI, SECTION B, LINE 15A	COMPENSATION COMPARABILITY STUDIES ARE REVIEWED EACH YEAR FOR ALL POSITIONS BY THE HUMAN RESOURCES DEPARTMENT. THE HUMAN RESOURCES DEPARTMENT HAS ACCESS TO VARIOUS COMPENSATION SURVEYS, WHICH ARE REVIEWED TO DETERMINE IF THE HOSPITAL'S COMPENSATION IS REASONABLE COMPARED TO OTHER FACILITIES. THE BOARD DELEGATES VICE PRESIDENT EXECUTIVE COMPENSATION APPROVAL TO THE CEO BASED ON THE ORGANIZATION'S COMPENSATION PHILOSOPHY IN CONJUCTION WITH MARKET BENCHMARKS. THE EXECUTIVE COMMITTEE REVIEWS AND APPROVES THE SALARIES OF OTHER KEY EMPLOYEES. THIS PROCESS WAS LAST COMPLETED IN 2021.
FORM 990, PART VI, SECTION C, LINE 19	FINANCIAL STATEMENTS ARE AVAILABLE THROUGH FILINGS WITH BONDING AUTHORITY. GOVERNING DOCUMENTS AND THE CONFLICT OF INTEREST POLICY ARE NOT MADE AVAILABLE TO THE PUBLIC.
FORM 990, PART XI, LINE 9:	CHANGE IN BENEFICIAL INTEREST IN PRAIRIE LAKES FOUNDATION -53,252. CHANGE IN HCI NET ASSETS 3,499,787.
FORM 990, PART XII, LINE 2C:	THIS PROCESS HAS NOT CHANGED FROM PRIOR YEAR.

Return Reference

Explanation

FORM 990, PART VI, SECTION A, LINE 1A

THE EXECUTIVE COMMITTEE SHALL BE COMPRISED OF THE OFFICERS OF THE CORPORATION. EXCEPT AS MAY BE LIMITED BY THE BOARD, THE EXECUTIVE COMMITTEE SHALL HAVE AND EXERCISE THE AUTHORITY OF THE BOARD IN THE MANAGEMENT OF THE BUSINESS OF THE CORPORATION. THE EXECUTIVE COMMITTEE SHALL ACT IN THE INTERVALS BETWEEN MEETINGS OF THE BOARD AND SHALL AT ALL TIMES BE SUBJECT TO THE CONTROL AND DIRECTION OF THE BOARD. THE EXECUTIVE COMMITTEE SHALL ALSO SERVE AS THE CORPORATION'S COMPENSATION COMMITTEE, UNLESS IT OR THE BOARD DELEGATES THOSE RESPONSIBILITIES TO ANOTHER COMMITTEE OF THE BOARD. THE EXECUTIVE COMMITTEE SHALL NOT USURP THE FUNCTIONS OF THE OTHER STANDING COMMITTEES, ALTHOUGH IT WILL COORDINATE PROJECTS, TASKS AND COMMUNICATIONS AMONG SUCH COMMITTEES. A MAJORITY OF THE EXECUTIVE COMMITTEE SHALL CONSTITUTE A QUORUM FOR THE TRANSACTION OF ANY BUSINESS.

FORM 990, PART VI, SECTION B, LINE 11B

EXECUTIVE MANAGEMENT REVIEWS THE FORM 990 IN DETAIL. THE FORM 990 IS PRESENTED TO THE FINANCE COMMITTEE CHAIR FOR FINAL REVIEW PRIOR TO FILING WITH THE IRS.

FORM 990, PART VI, SECTION B, LINE 12C

A CONFLICT OF INTEREST STATEMENT IS SIGNED BY ALL BOARD MEMBERS ANNUALLY. THIS STATEMENT DISCLOSES ANY AREAS THAT MAY POTENTIALLY PRESENT A CONFLICT OF INTEREST WITH THEMSELVES OR FAMILY MEMBERS. THE CONFLICT OF INTEREST POLICY IS MONITORED BY THE CEO AND THE BOARD. MEMBERS WILL EXCUSE THEMSELVES DURING BOARD MEETING FROM ANY DISCUSSION OR VOTING ON AN ISSUE WHERE THERE MAY BE A CONFLICT OF INTEREST.

FORM 990, PART VI, SECTION B, LINE 15A

COMPENSATION COMPARABILITY STUDIES ARE REVIEWED EACH YEAR FOR ALL POSITIONS BY THE HUMAN RESOURCES DEPARTMENT. THE HUMAN RESOURCES DEPARTMENT HAS ACCESS TO VARIOUS COMPENSATION SURVEYS, WHICH ARE REVIEWED TO DETERMINE IF THE HOSPITAL'S COMPENSATION IS REASONABLE COMPARED TO OTHER FACILITIES. THE BOARD DELEGATES VICE PRESIDENT EXECUTIVE COMPENSATION APPROVAL TO THE CEO BASED ON THE ORGANIZATION'S COMPENSATION PHILOSOPHY IN CONJUCTION WITH MARKET BENCHMARKS. THE EXECUTIVE COMMITTEE REVIEWS AND APPROVES THE SALARIES OF OTHER KEY EMPLOYEES. THIS PROCESS WAS LAST COMPLETED IN 2021.

FORM 990, PART VI, SECTION C, LINE 19

FINANCIAL STATEMENTS ARE AVAILABLE THROUGH FILINGS WITH BONDING AUTHORITY. GOVERNING DOCUMENTS AND THE CONFLICT OF INTEREST POLICY ARE NOT MADE AVAILABLE TO THE PUBLIC.

FORM 990, PART XI, LINE 9:

CHANGE IN BENEFICIAL INTEREST IN PRAIRIE LAKES FOUNDATION -53,252. CHANGE IN HCI NET ASSETS 3,499,787.

FORM 990, PART XII, LINE 2C:

THIS PROCESS HAS NOT CHANGED FROM PRIOR YEAR.

For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.

Cat. No. 51056K

Schedule O (Form 990) 2021

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