• Prairie Healthcare Servcies, LLC

    5920 Hohman Av. Hammond, IN 46320

    P: 219-240-1246, F: 219-240-1247

  • Conflict of interest policy and disclosure form

  • A conflict of interest exists when there is evidence of or the appearance that an employee’s personal
    interests have influenced or may influence Agency transactions or operations, or that these interests take
    precedence over the interests, goals, and/or mission of the Agency. A conflict of interest may relate to
    you, your spouse/partner, family member, business interests, and/or associates in areas such as:

    • I (or a party related to me) hold, directly or indirectly a position of financial interest in an
      outside concern from which Prairie Healthcare Servcies, LLC secure goods or services.
    • I (or a party related to me) render directive, managerial, or consultative service to, or am an
      employee of, any outside concern that does business with Prairie Healthcare Servcies, LLC.
    • I have accepted gifts or other benefits from any outside concern that does, or is seeking to do,
      business with Prairie Healthcare Servcies, LLC At Prairie Healthcare Servcies, LLC.
    • I have participated in management decisions concerning
      transactions that affect or benefit me, my family, or my personal financial interests.


    A party related to me has received or continues to receive services from Healthcare Servcies, LLC
    is responsible for knowing what conflicts might exist and to manage, reduce, or eliminate those
    conflicts. The key to handling these potential conflicts is full disclosure of any potential conflict or the
    appearance of a conflict. It should be noted that we believe it appropriate to disclose any family
    members that may be supported by, employed by, a vendor of, or business associate Healthcare Servcies, LLC
    of Healthcare Servcies, LLC Each employee will complete an annual conflict of interest disclosure
    form to inform Healthcare Servcies, LLC of situations that pose or may give the appearance of conflict
    of interest.


    If you have questions as to whether a conflict of interest exists, we encourage you to discuss this
    with Human Resources or ’s Compliance Officer and/or disclose this
    information on the form.

    I certify by signing below I acknowledge receipt of the Employee Conflict of Interest Policy and that I
    have accurately completed this disclosure form to the best of my knowledge.

  • Please check the statement that pertain to your disclosure:

  • Prairie Healthcare Servcies, LLC

    5920 Hohman Av. Hammond, IN 46320

    P: 219-240-1246, F: 219-240-1247

  • * I understand that it is my responsibility to contact Prairie Healthcare Servcies, LLC Corporate
    Compliance Officer to complete a new Employee Conflict of Interest and Disclosure form to notify Prairie Healthcare Servcies, LLC of any changes and/or additions that may occur throughout the
    year.

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