2023-02-15T13:18:25-06:00 2022-03-31 460403496 CASEY PETERSON LTD 909 ST JOSEPH ST STE 101 RAPID CITY SD 57701 990 2021-04-01 450340688 WEST RIVER HEALTH SERVICES WEST 7015674561 1000 HIGHWAY 12 HETTINGER ND 58639 NATHAN STADHEIM CFO 7015674561 2023-02-15 1 NATHAN STADHEIM 999009999 KAYLA GIESEY CPA P01874520 6053481930 2023-02-15 3 AAL1 IAL1 2021 2023-03-07 01:45:13Z WEST RIVER REGIONAL MEDICAL CENTER ALYSON KORNELE 1000 HIGHWAY 12 HETTINGER ND 58639 30939617 0 X WWW.WRHS.COM X 1977 ND PROVIDE COMPREHENSIVE HEALTH AND WELLNESS SERVICES TO THE RESIDENTS AND VISITORS OF THE REGION. 8 3 307 0 0 0 7225984 1996241 26555441 28848124 72937 38134 584537 54655 34438899 30937154 0 750 0 0 15854038 16088870 0 0 97137 11043163 11919868 26897201 28009488 7541698 2927666 32561902 34739772 3962039 3212243 28599863 31527529 X THE MISSION OF WEST RIVER HEALTH SERVICES (WRHS) IS TO PROVIDE COMPREHENSIVE HEALTH AND WELLNESS SERVICES TO THE RESIDENTS AND VISITORS OF THE REGION. 0 0 25416949 750 28848124 WEST RIVER HEALTH SERVICES (WRHS) IS A NATIONALLY-RECOGNIZED RURAL HEALTH CARE DELIVERY SYSTEM INCLUDING HOSPITAL, SWING BED, SURGERY, LAB, RADIOLOGY, EMERGENCY ROOM, SEVEN CLINICS, EYE CLINIC, VISITING NURSE SERVICES, AMBULANCE SERVICE, FAMILY THERAPY, REHABILITATIVE THERAPIES INCLUDING PHYSICAL THERAPY, OCCUPATIONAL THERAPY AND SPEECH THERAPY.IN FY 2022 WRHS PROVIDED ACUTE CARE SERVICES TO 411 PATIENTS FOR A TOTAL OF 1,559 DAYS OF CARE. SWING BED SERVICES WERE PROVIDED TO 69 PATIENTS FOR A TOTAL OF 692 DAYS OF CARE. IN ADDITION, 327 DAYS OF OBSERVATION CARE WERE PROVIDED. THERE WERE 1,713 EMERGENCY ROOM VISITS DURING THE YEAR. THERE WERE 34 BABIES BORN DURING THE YEAR WITH A TOTAL OF 59 DAYS OF CARE PROVIDED. THERE WERE A TOTAL OF 734 SURGICAL CASES DURING THE YEAR, WITH 642 OF THOSE BEING DONE ON AN OUTPATIENT BASIS. THE AMBULANCE CREW MADE 357 AMBULANCE RUNS/TRANSFERS THROUGHOUT THE YEAR. THERE WERE 37,347 CLINIC ENCOUNTERS TO THE SIX CLINICS. ANCILLARY SERVICES WERE PROVIDED AS FOLLOWS: 201,503 LAB TESTS; 6,480 RADIOLOGY TESTS; 2,809 RESPIRATORY THERAPY PROCEDURES; 20,953 MEALS TO PATIENTS, VISITORS, AND EMPLOYEES. THROUGHOUT THE YEAR THERE WERE 3,601 HOME VISITS BY REGISTERED NURSES AND 2,200 COUNSELING VISITS. 25416949 1 1 0 0 0 0 0 0 0 0 1 0 0 0 0 1 1 1 0 0 0 0 0 0 0 0 1 1 0 0 1 0 0 0 0 0 0 1 0 0 0 0 0 0 1 0 0 0 1 83 0 1 307 1 0 0 0 0 0 0 0 0 0 0 0 0 X 8 3 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 0 0 X THE ORGANIZATION 7015674561 1000 HIGHWAY 12 HETTINGER ND 58639 MATT BARNES CHAIRMAN 1.00 X X 170 0 0 LYNN BROWN VICE-CHAIRMAN 1.00 X X 210 0 0 KELLY PIERCE SECRETARY/TREASURER 1.00 X X 140 0 0 TROY MOSBRUCKER REPRESENTATIVE 1.00 X 80 0 0 KEVIN ERDAHL REPRESENTATIVE 1.00 X 110 0 0 BRETT HENDERSON REPRESENTATIVE 1.00 X 130 0 0 DAVE ERICKSON REPRESENTATIVE 1.00 X 120 0 0 DR MARK KRISTY MEDICAL STAFF LIAISON 40.00 X 305201 0 40158 MATT SHAHAN CEO 37.00 3.00 X 198503 0 38673 NATHAN STADHEIM CFO 32.00 8.00 X 135601 0 30347 KAREN ANDRES PHYSICIAN 40.00 X 367137 0 30894 CATHERINE SHIREK PHYSICIAN 40.00 X 283540 0 36457 STEVE KILWEIN PHYSICIAN 40.00 X 275505 0 41514 JOSHUA RANUM PHYSICIAN 40.00 X 294248 0 18142 KENT HOERAUF PHYSICIAN 39.00 1.00 X 264259 13200 32563 2124954 13200 268748 24 0 1 0 DTN STAFFING INC 1200 COLLINS AVE MANDAN ND 58554 LOCUM STAFFING 381344 UNITIMED RECRUITING RESOURCES LLC PO BOX 8265 RAPID CITY SD 57709 LOCUM STAFFING 363576 MEDICAL SOLUTIONS LLC DBA AUREUS NURSING 13609 CALIFORNIA ST OMAHA NE 68154 LOCUM NURSING/RADIOLOGY SERVICES 325543 BARTON ASSOCIATES INC PO BOX 417844 BOSTON MA 02241 LOCUM MEDICAL PROVIDER 296574 ARNHOLD MEDICAL INC 26881 NORTHSTAR LN PEQUOT LAKES MN 56472 LOCUM MEDICAL PROVIDER 255269 12 126390 1868026 1825 1996241 PATIENT SERVICE REVENUE 621110 28269802 28269802 OTHER OPERATING REVENUE 621110 432384 432384 ASSISTED LIVING BUILDING RENT 900002 92100 92100 CAFETERIA 722514 53838 53838 28848124 39942 39942 39500 655 38845 38845 38845 1808 -1808 -1808 -1808 INSURANCE PROCEEDS 900099 15810 15810 15810 30937154 28848124 0 92789 X 750 750 749443 345359 404084 12657870 11955734 626694 75442 387311 366707 18299 2305 1401594 1343198 49957 8439 892652 823039 64560 5053 7765 7765 43656 43656 4435706 4098273 336799 634 62339 62339 78637 74110 4198 329 486775 444566 40748 1461 127574 124147 3425 2 116580 72876 43704 13756 13756 1330631 1162706 165206 2719 305591 286467 18569 555 SUPPLIES - MEDICAL AND 3267668 3251016 16559 93 REPAIRS & MAINTENANCE 1003772 540678 463005 89 BAD DEBT EXPENSE 272163 272163 MINOR EQUIPMENT 143485 109190 34295 223770 132214 91540 16 28009488 25416949 2495402 97137 9445537 13226007 4308213 4486261 600836 579452 405578 219490 39648210 28381637 11841683 11266573 4648288 4664656 1311767 297333 32561902 34739772 2041289 1830354 879718 525657 1041032 856232 3962039 3212243 X 28599863 31527529 28599863 31527529 32561902 34739772 2927666 0 X X 0 1 X 1 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 18000 90113 108113 1981026 21331750 14692388 8620388 36171 15129915 12967738 2198348 1061235 721511 339724 11266573 X 30695822 -241987 -241987 30937809 -655 -655 30937154 27768156 655 655 27767501 241987 241987 28009488 PART X, LINE 2: AS OF MARCH 31, 2022, WRHS HAD NO UNCERTAIN TAX POSITIONS THAT QUALIFY FOR EITHER RECOGNITION OR DISCLOSURE IN THE FINANCIAL STATEMENTS. WRHS' INCOME TAX FILINGS ARE SUBJECT TO AUDIT BY VARIOUS TAXING AUTHORITIES. WRHS IS NO LONGER SUBJECT TO FEDERAL AND STATE INCOME TAX EXAMINATIONS BY TAXING AUTHORITIES FOR FISCAL YEARS BEFORE 2019. MANAGEMENT CONTINUALLY EVALUATES EXPIRING STATUTES OF LIMITATION, AUDITS, PROPOSED SETTLEMENTS, CHANGES IN TAX LAW, AND NEW AUTHORITATIVE RULINGS. WRHS BELIEVES ESTIMATES ARE APPROPRIATE BASED ON CURRENT FACTS AND CIRCUMSTANCES. INTEREST AND PENALTIES ASSESSED BY INCOME TAXING AUTHORITIES, IF ANY, ARE INCLUDED IN INTEREST EXPENSE. PART XI, LINE 2D - OTHER ADJUSTMENTS: BAD DEBT EXPENSE -272,163. FFCRA CREDITS NETTED AGAINST SALARIES EXPENSE FOR 990 REPORTING 30,176. PART XI, LINE 4B - OTHER ADJUSTMENTS: RENTAL EXPENSES -655. PART XII, LINE 2D - OTHER ADJUSTMENTS: RENTAL EXPENSES 655. PART XII, LINE 4B - OTHER ADJUSTMENTS: BAD DEBT EXPENSE 272,163. FFCRA CREDITS NETTED AGAINST SALARIES EXPENSE FOR 990 REPORTING -30,176. PART XI LINE 4B EXPENSES RELATED TO RENTAL PROPERTY ARE INCLUDED IN EXPENSES FOR PURPOSES OF THE AUDITED FINANCIAL STATEMENTS; HOWEVER, THESE EXPENSES ARE NETTED AGAINST THE GROSS RENT IN REVENUE FOR 990 PRESENTATION. PART XII LINE 2D RENTAL EXPENSES ARE NETTED AGAINST THE GROSS RENT REVENUE FOR PURPOSES OF THE 990, BUT ARE REPORTED IN EXPENSES IN THE AUDITED FINANCIAL STATEMENTS. 1 1 X 1 X 1 X 0 1 0 0 97972 97972 0.00350 2241867 1573734 668133 0.02410 2339839 1573734 766105 0.02760 14571 0 14571 0.00050 6703358 5633551 1069807 0.03860 6717929 5633551 1084378 0.03910 9057768 7207285 1850483 0.06670 5759 5759 0.00020 236868 236868 0.00850 242627 242627 0.00870 1 272163 0 13084033 13474989 -390956 X 1 1 1 1 WEST RIVER HEALTH SERVICES 1000 HIGHWAY 12 HETTINGER ND 58639 WRHS.COM X X X X X CLINIC & 5 RHC'S - ALL PROVIDER BASED WEST RIVER HEALTH SERVICES 1 0 0 1 X X X X X X X X 20 1 0 0 1 X HTTP://WWW.WRHS.COM X 1 20 1 HTTP://WWW.WRHS.COM 0 1 X 100.000000000000 200.000000000000 1 1 X X X 1 X WRHS.COM X WRHS.COM X WRHS.COM X X X X 1 X 0 X X 1 X 0 0 WEST RIVER HEALTH SERVICES PART V, SECTION B, LINE 5: AS PART OF THE CHNA PROCESS, DATA WAS COLLECTED USING A SURVEY OF AREA RESIDENTS, ONE-ON-ONE KEY INFORMANT INTERVIEWS WITH COMMUNITY LEADERS REPRESENTING THE BROAD INTERESTS OF THE COMMUNITY, AS WELL AS A WIDE RANGE OF SECONDARY DATA SOURCES. THROUGH ONE OR MORE OF THE ABOVE METHODS, INPUT WAS GATHERED FROM THE BOARDS OF DIRECTORS OF THE HEALTH SYSTEM, PHYSICIANS, EMERGENCY MEDICAL PERSONNEL, FITNESS PROVIDERS, HOME CARE PROVIDERS, QUALITY MANAGEMENT PERSONNEL, ECONOMIC DEVELOPMENT AND CHAMBER OF COMMERCE LEADERS, LONG-TERM CARE PROVIDERS, EDUCATIONAL SYSTEM REPRESENTATIVES, CLERGY REPRESENTATIVES, PHARMACISTS, AS WELL AS PUBLIC HEALTH AND SOCIAL SERVICES PERSONNEL. THE FEEDBACK AND DATA WAS ALL REVIEWED AND CONSIDERED AS NEEDS WERE EVALUATED AND PLANS WERE DRAFTED. WEST RIVER HEALTH SERVICES PART V, SECTION B, LINE 11: THE TOP ISSUES IDENTIFIED AS PART OF THE ASSESSMENT PROCESS WERE ATTRACTING AND RETAINING YOUNG FAMILIES, AVAILABILITY OF PRIMARY CARE PROVIDERS (MD, DO, NP, PA) AND NURSES, ABILITY TO RETAIN PRIMARY CARE PROVIDERS AND NURSES, AND NOT ENOUGH JOBS WITH LIVABLE WAGES.TO ASSIST IN ATTRACTING AND RETAINING YOUNG FAMILIES TO THE AREA, WE ARE ENCOURAGING STAFF TO BE MORE INVOLVED WITH THE COMMUNITIES WE SERVE TO IMPROVE ALIGNMENT AND COHESIVENESS. WE ALSO BELIEVE THE EMPHASIS ON HEALTH AND WELLNESS WILL BE ATTRACTIVE TO YOUNG FAMILIES.TO IMPROVE AVAILABILITY OF PRIMARY CARE PROVIDERS AND NURSES CLINIC HOURS WILL BE EXPANDED AS MUCH AS POSSIBLE GIVEN STAFFING CONSTRAINTS. THE AIM WILL BE TO SHORTEN APPOINTMENT SCHEDULING WAIT TIMES.RETENTION OF PRIMARY CARE PROVIDERS AND NURSES HAS ALWAYS BEEN A PRIORITY. TO ASSIST IN THIS EFFORT, WRHS IS COMMITTED TO MAINTAINING UP-TO-DATE FACILITIES TECHNOLOGY, AND EQUIPMENT TO PROVIDE THE TOOLS CARE PROVIDERS NEED TO PROVIDE EXCELLENT PATIENT CARE.ENSURING A GOOD SUPPLY OF JOBS WITH LIVABLE WAGES IN THE COMMUNITY IS NOT AN ISSUE WRHS CAN ADDRESS ON ITS OWN. THAT SAID, WRHS IS COMMITTED TO PAYING COMPETITIVE WAGES. ANALYSIS AND COMPARISON OF SALARY LEVELS FOR ALL POSITIONS IS CONDUCTED ANNUALLY TO ENSURE APPROPRIATE ADJUSTMENTS ARE MADE AND COMPETITIVE LEVELS ARE MAINTAINED. 1 1 - WEST RIVER EYE CENTER 1000 HWY 12 HETTINGER ND 58639 CLINIC PART I, LINE 7, COLUMN (F): THE BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 25, COLUMN (A), BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE IN THIS COLUMN IS $ 272,163. PART II, COMMUNITY BUILDING ACTIVITIES: THE DECLINING AND AGING POPULATION IS OF GREAT CONCERN FOR RURAL AMERICA AND ESPECIALLY THE WRHS SERVICE AREA. THE ACTIVITIES CONDUCTED ARE DESIGNED TO PROVIDE THE YOUNGER POPULATION WITH GOOD EXPERIENCES TO HELP THEM SEE THE VALUE OF LIVING AND RAISING FAMILIES IN A SMALL COMMUNITY. IN ADDITION, YOUNG FAMILIES NEED A WAY TO EARN A LIVING. PART III, LINE 2: THE FOOTNOTE TO THE ORGANIZATION'S FINANCIAL STATEMENTS CAN BE FOUND ON PAGES 15 - 17 OF THE ATTACHED FINANCIAL STATEMENTS. PART III, LINE 3: PATIENT ACCOUNTS ARE WRITTEN OFF TO BAD DEBT AFTER EVERY EFFORT IS MADE TO COLLECT THE BALANCE AND PATIENTS ARE GIVEN OPPORTUNITIES TO COMPLETE CHARITY CARE APPLICATIONS OR SET UP PAYMENT PLANS. ALL DISCOUNTS AND CONTRACTUAL ADJUSTMENTS ARE APPLIED TO ACCOUNTS BEFORE THEY ARE WRITTEN OFF TO BAD DEBT. CURRENT PAYMENTS ON ACCOUNTS PREVIOUSLY WRITTEN OFF AS BAD DEBT REDUCES BAD DEBT EXPENSE.THE ESTIMATED AMOUNT OF THE ORGANIZATION'S BAD DEBT EXPENSE THAT IS ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER THE ORGANIZATION'S CHARITY CARE PROGRAM WAS BASED ON THE PERCENTAGE OF CHARITY CARE TO GROSS CHARGES TIMES THE STATED BAD DEBT EXPENSE. PART III, LINE 4: THE FOOTNOTE TO THE ORGANIZATION'S FINANCIAL STATEMENTS CAN BE FOUND ON PAGES 15 - 17 OF THE ATTACHED 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 THE CENTERS FOR MEDICARE AND MEDICAID SERVICES. PART III, LINE 9B: FOR THOSE PATIENTS WHO RECEIVE DISCOUNTED CARE UNDER THE FAP, THE REMAINING SELF-PAY PORTION FALLS UNDER THE SAME COLLECTIONS POLICY AS ALL OTHER PATIENT ACCOUNTS. THE HOSPITAL POLICY IS TO SEND THE UNPAID AMOUNTS TO COLLECTIONS 120 DAYS AFTER THE FIRST STATEMENT; HOWEVER THE HOSPITAL MAKES ALL EFFORTS TO WORK WITH THE PATIENTS TO COLLECT THE UNPAID AMOUNT BEFORE THEY ACTUALLY SEND IT TO COLLECTIONS. THE PATIENT ACCOUNT MANAGER MAKES SEVERAL ATTEMPTS TO MAKE PAYMENT ARRANGEMENTS THROUGH PHONE CONVERSATIONS AND PERSONAL CONTACT WITH THE PATIENT. PART VI, LINE 2: AT LEAST ANNUALLY, THE BOARD OF DIRECTORS, PROVIDERS, AND ADMINISTRATION GATHER TO DISCUSS THE NEEDS OF OUR PATIENTS ALONGS WITH THE STRATEGIC DIRECTION OF THE ORGANIZATION. THE PROVIDERS ARE SEEING MANY PATIENTS ON A DAILY BASIS AND SEE THE HEALTHCARE NEEDS OF OUR PATIENTS. THIS, COUPLED WITH THE INPUT FROM THE BOARD WHICH IS MADE UP OF COMMUNITY MEMBERS FROM ACROSS THE GEOGRAPHICAL AREA WE SERVE AND LEADERSHIP OF THE ORGANIZATION PROVIDES MUCH INSIGHT INTO THE NEEDS OF THE COMMUNITY. PART VI, LINE 3: WRHS ATTEMPTS TO INFORM ALL PATIENTS OF THE AVAILABILITY OF FINANCIAL ASSISTANCE. THE FINANCIAL ASSISTANCE POLICY IS POSTED ON OUR WEBSITE, AVAILABLE IN ALL PUBLIC LOCATIONS WITHIN OUR FACILITY, IS DISTRIBUTED TO PATIENTS UPON ADMISSION AND/OR DISCHARGE. THE POLICY IS PROVIDED FREE OF CHARGE UPON REQUEST FROM ANYONE. THE EXISTENCE OF THE POLICY AND THE DIRECT URL IS LISTED ON OUR STATEMENTS. INFORMATION SHEETS SUMMARIZING THE POLICY IS PROVIDED TO PUBLIC AGENCIES AND OTHER NONPROFIT ORGANIZATIONS WITHIN OUR SERVICE AREA IN AN EFFORT TO INFORM ALL POTENTIAL PATIENTS OF ITS EXISTENCE. IN ADDITION, WE HAVE TWO FINANCIAL COUNSELORS THAT WORK WITH PATIENTS DURING THE PREAUTHORIZATION, REGISTRATION, AND BILLING PROCESSES TO ENSURE THE AVAILABILITY OF ASSISTANCE IS COMMUNICATED ALONG WITH HELP OF THE APPLICATION IS OFFERED.IN ADDITION TO OFFERING INTERNAL FINANCIAL ASSISTANCE, WE REACH OUT TO PATIENTS DURING THE OPEN ENROLLMENT PROCESS TO REMIND THEM OF ASSISTANCE AVAILABLE THROUGH HEALTHCARE.GOV. AS PART OF THE APPLICATION PROCESS FOR INTERNAL FINANCIAL ASSISTANCE, WE ALSO DIRECT THEM TO THEIR COUNTY SOCIAL SERVICES OFFICE TO LEARN MORE ABOUT AND APPLY FOR MEDICAID. PART VI, LINE 4: THE COMMUNITY SERVED BY WRHS IS MADE UP OF SEVERAL TOWNS INCLUDING BOWMAN, BUCYRUS, HAYNES, HETTINGER, MOTT, NEW ENGLAND, REEDER IN NORTH DAKOTA AND LEMMON, SOUTH DAKOTA. THE CORE SERVICE AREA IS COMPRISED OF SIX COUNTIES ACROSS NORTH DAKOTA AND SOUTH DAKOTA. THESE COUNTIES INCLUDE 10,000 SQUARE MILES WITH A POPULATION OF APPROXIMATELY 13,000 PEOPLE. FARMING AND RANCHING IS THE PRIMARY ECONOMIC DRIVER IN THE AREA. THE POPULATION IS DECLINING AND GETTING OLDER AS TIME GOES ON. PART VI, LINE 5: THE BOARD OF DIRECTORS IS COMPRISED OF MEMBERS FROM ACROSS OUR SERVICE AREA WHICH SPANS NUMEROUS COMMUNITIES. THIS ALLOWS LEADERS FROM EACH OF THOSE COMMUNITIES TO COME TOGETHER TO PROVIDE INPUT ON SERVICES PROVIDED BY THE ORGANIZATION, NEEDS OF THEIR COMMUNITIES, AS WELL AS POSITIVE EXPERIENCES FROM THEIR COMMUNITIES. THESE EXPERIENCES ARE NOT ONLY RELATED TO HEALTHCARE, BUT SMALL TOWN LIFE IN GENERAL. THE ORGANIZATION EMPLOYS MANY INDIVIDUALS WITHIN OUR SERVICE AREA CONTRIBUTING TO THE LOCAL ECONOMIES. THE LARGEST ISSUE FACING RURAL AMERICA IS THE LOSS OF POPULATION, ESPECIALLY WORKING AGE FAMILIES. ANY LOCAL BUSINESSES CONTRIBUTE GREATLY TO THE HEALTH OF RURAL COMMUNITIES THROUGH THE ECONOMIC IMPACT. IN REVIEWING POTENTIAL CONTRACTS AND SERVICES PROVIDERS, PREFERENCE IS GIVEN TO LOCAL VENDORS WHICH IS VITAL TO KEEPING OUR COMMUNITIES ALIVE. X X X 0 0 0 0 0 0 0 0 0 KAREN ANDRES PHYSICIAN 367137 0 0 0 0 0 0 0 30894 0 398031 0 0 0 DR MARK KRISTY MEDICAL STAFF LIAISON 305201 0 0 0 0 0 8700 0 31458 0 345359 0 0 0 CATHERINE SHIREK PHYSICIAN 283540 0 0 0 0 0 8506 0 27951 0 319997 0 0 0 STEVE KILWEIN PHYSICIAN 275505 0 0 0 0 0 8341 0 33173 0 317019 0 0 0 JOSHUA RANUM PHYSICIAN 294248 0 0 0 0 0 8700 0 9442 0 312390 0 0 0 KENT HOERAUF PHYSICIAN 264259 13200 0 0 0 0 7928 0 24635 0 296822 13200 0 0 MATT SHAHAN CEO 198503 0 0 0 0 0 6620 0 32053 0 237176 0 0 0 NATHAN STADHEIM CFO 135601 0 0 0 0 0 4528 0 25819 0 165948 0 0 0 PART I, LINE 3 THE WEST RIVER HEALTH SERVICES BOARD OF DIRECTORS DETERMINES THE CEO'S COMPENSATION VIA COMPENSATION COMMITTEE, COMPENSATION SURVEY OR STUDY, AND APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE. TARA JORGENSON SPOUSE OF CODY JORGENSON, DIRECTOR ON WRHSF BOARD (PARENT ORGANIZATION) 82982 COMPENSATION 0 KYLEE STADHEIM SPOUSE OF NATHAN STADHEIM, CFO 21561 COMPENSATION 0 KATHERINA SHAHAN SPOUSE OF MATT SHAHAN, CEO 27987 COMPENSATION 0 AMIE HENDERSON SPOUSE OF BRETT HENDERSON, DIRECTOR ON WRHS BOARD 76150 COMPENSATION 0 JACQUELYN HEDSTROM SPOUSE OF STEVE HEDSTROM, DIRECTOR ON WRHSF BOARD (PARENT ORGANIZATION) 103030 COMPENSATION 0 ALAINA STADHEIM-OLSON SISTER OF NATHAN STADHEIM, CFO 146139 COMPENSATION 0 COURTNEY HULM SISTER OF MATT BARNES, DIRECTOR ON WRHS BOARD 61333 COMPENSATION 0 DENAE HENDERSON MOTHER OF BRETT HENDERSON, DIRECTOR ON WRHS BOARD 7262 COMPENSATION 0 BETHANY ERICKSON DAUGHTER OF DAVE ERICKSON, DIRECTOR ON WRHS BOARD 42245 COMPENSATION 0 AUDREY SKOGEN MOTHER OF SETH SKOGEN, DIRECTOR ON WRHSF BOARD (PARENT ORGANIZATION) 20128 COMPENSATION 0 DANA ANDRESS SISTER OF DAVE ERICKSON, DIRECTOR ON WRHS BOARD 33983 COMPENSATION 0 DANELLE PIERCE SPOUSE OF KELLY PIERCE, DIRECTOR ON WRHS BOARD 16601 COMPENSATION 0 FORM 990, PART VI, SECTION A, LINE 1A THERE IS AN EXECUTIVE COMMITTEE THAT HAS AUTHORITY TO TRANSACT ALL REGULAR BUSINESS OF THE CORPORATION DURING THE PERIOD BETWEEN THE MEETINGS OF THE BOARD OF DIRECTORS. MINUTES OF THE EXECUTIVE COMMITTEE SHALL BE SUBMITTED TO THE BOARD AND ITS ACTION SHALL BE SUBJECT TO THE APPROVAL OR DISAPPROVAL AT THE NEXT REGULAR BOARD MEETING. THIS COMMITTEE WILL MEET WHEN CALLED BY THE CHAIRMAN. THE EXECUTIVE COMMITTEE CONSISTS OF THE CHAIRMAN, VICE CHAIR, SECRETARY/TREASURER, PAST CHAIRMAN, MEDICAL STAFF REPRESENTATIVE OF THE BOARD, AND TWO OTHER BOARD MEMBERS. FORM 990, PART VI, SECTION A, LINE 6 WEST RIVER HEALTH SERVICES FOUNDATION IS THE SOLE MEMBER OF THE ORGANIZATION. FORM 990, PART VI, SECTION A, LINE 7A AS THE SOLE MEMBER, WRHS FOUNDATION APPOINTS THE BOARD MEMBERS OF WRHS. FORM 990, PART VI, SECTION A, LINE 7B AS A SOLE MEMBER, WRHS FOUNDATION APPROVES ALL AMENDMENTS TO THE ARTICLES OF INCORPORATION AND BYLAWS, DETERMINES APPROVED DEBT LEVELS AND APPROVES INDIVIDUAL DEBT TRANSACTIONS THAT EXCEED THE APPROVED DEBT LEVELS, APPROVES DISSOLUTION OR MERGER OF THE ORGANIZATION, AND APPROVES THE SALE OR TRANSFER OF ANY CAPITAL ASSETS HAVING A PURCHASE PRICE OR MARKET VALUE GREATER THAN $100,000. FORM 990, PART VI, SECTION B, LINE 11B THE CFO AND CEO WILL REVIEW THE FORM 990 PRIOR TO THE COMPLETED FORM 990 BEING DISTRIBUTED ELECTRONICALLY TO THE BOARD MEMBERS FOR THEIR REVIEW AND COMMENTS. THE FORM 990 IS ALSO REVIEWED AND DISCUSSED AT A BOARD MEETING. FORM 990, PART VI, SECTION B, LINE 12C ALL MEDICAL STAFF, EMPLOYEES, AND BOARD MEMBERS ARE REQUIRED TO DISCLOSE ANY POTENTIAL CONFLICTS. POTENTIAL CONFLICTS ARE REVIEWED BY THE CEO. INDIVIDUALS WITH CONFLICTS ABSTAIN FROM VOTING, AND THIS ACTION IS NOTED BY BOARD MINUTES. FORM 990, PART VI, SECTION B, LINE 15A CEO: EACH BOARD AND MEDICAL STAFF MEMBER ANNUALLY COMPLETES AN EVALUATION FORM ON THE CEO'S PERFORMANCE. THE CHAIRMAN OF EXECUTIVE COMMITTEE TABULATES THE RESULTS AND REVIEWS THEM WITH THE OTHER MEMBERS OF THE EXECUTIVE COMMITTEE. THE RESULTS ARE PRESENTED TO THE FULL BOARD OF DIRECTORS WHO HAVE FINAL AUTHORITY IN DETERMINING COMPENSATION. COMPARABILITY DATA FROM THE STATE HOSPITAL ASSOCIATION, AS WELL AS OTHER COMPARATIVE INDUSTRY INFORMATION, IS USED IN DETERMINING COMPENSATION. CFO: THE CEO REVIEWS THE CFO'S PERFORMANCE AND USES COMPARABILITY DATA IN DETERMINING COMPENSATION. ALL OTHER EMPLOYEES: THE ADMINISTRATIVE STAFF USES COMPARABLE DATA IN SETTING COMPENSATION FOR EACH LEVEL OF EMPLOYEE. COMPENSATION IS REVIEWED ANNUALLY. FORM 990, PART VI, SECTION C, LINE 19 ADMINISTRATIVE REPRESENTATIVES OF THE ORGANIZATION WILL PROVIDE THE GOVERNING BOARD DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS UPON WRITTEN OR VERBAL REQUEST TO ADMINISTRATIVE REPRESENTATIVES OF THE ORGANIZATION. FORM 990, PART IX, LINE 11G PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 4,098,273. MANAGEMENT AND GENERAL EXPENSES 336,799. FUNDRAISING EXPENSES 634. TOTAL EXPENSES 4,435,706. PART XII, LINE 2C PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR. WESTERN HORIZONS LIVING CENTER 1104 HIGHWAY 12 HETTINGER SD 58369 260794602 LONG-TERM CARE/ASSISTED LIVING FACILITY ND 501C LINE 10 WEST RIVER HEALTH SERVICES FOUNDATION 0 WEST RIVER HEALTH SERVICES FOUNDATION 1000 HIGHWAY 12 HETTINGER SD 58369 450411825 FUNDRAISING ND 501C LINE 12C, III-FI 0 0 0 1 1 0 0 0 0 0 1 0 0 0 0 0 0 1 0 0 WEST RIVER HEALTH SERVICES FOUNDATION C 126390 CASH PAID WEST RIVER HEALTH SERVICES FOUNDATION D 25281 CASH PAID WESTERN HORIZONS LIVING CENTER D 24538 CASH PAID WESTERN HORIZONS LIVING CENTER J 92100 LEASE AGREEMENT WEST RIVER HEALTH SERVICES FOUNDATION Q 115041 CASH PAID WESTERN HORIZONS LIVING CENTER Q 150731 CASH PAID