2021-02-10T17:36:03-06:00 2020-03-31 460403496 CASEY PETERSON LTD 909 ST JOSEPH ST STE 101 RAPID CITY SD 57701 990 2019-04-01 450340688 WEST RIVER HEALTH SERVICES WEST 7015674561 1000 HIGHWAY 12 HETTINGER ND 58639 NATHAN STADHEIM CFO 7015674561 2021-02-09 1 KAYLA GIESEY CPA P01874520 6053481930 2021-02-10 2019 2022-09-23 18:48:47Z WEST RIVER REGIONAL MEDICAL CENTER MATT SHAHAN 1000 HIGHWAY 12 HETTINGER ND 58639 27073083 0 X WWW.WRHS.COM X 1977 ND PROVIDE COMPREHENSIVE HEALTH AND WELLNESS SERVICES TO THE RESIDENTS AND VISITORS OF THE REGION. 9 7 303 0 0 0 532306 346185 26389647 26566272 42749 58957 40011 88510 27004713 27059924 1093772 0 0 0 14841561 14974921 0 0 106875 10477766 11639649 26413099 26614570 591614 445354 22720773 23935255 2107962 2877090 20612811 21058165 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 24087098 26566272 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, HOME MEDICAL EQUIPMENT STORE, AND WELLNESS/FITNESS SERVICES.IN FY 2020 WRHS PROVIDED ACUTE CARE SERVICES TO 458 PATIENTS FOR A TOTAL OF 1,588 DAYS OF CARE. SWING BED SERVICES WERE PROVIDED TO 105 PATIENTS FOR A TOTAL OF 1,093 DAYS OF CARE. IN ADDITION, 374 DAYS OF OBSERVATION CARE WERE PROVIDED. THERE WERE 1,656 EMERGENCY ROOM VISITS DURING THE YEAR. THERE WERE 50 BABIES BORN DURING THE YEAR WITH A TOTAL OF 105 DAYS OF CARE PROVIDED. THERE WERE A TOTAL OF 607 SURGICAL CASES DURING THE YEAR, WITH 533 OF THOSE BEING DONE ON AN OUTPATIENT BASIS. THE AMBULANCE CREW MADE 227 AMBULANCE RUNS/TRANSFERS THROUGHOUT THE YEAR. THERE WERE 37,410 CLINIC ENCOUNTERS TO THE SIX CLINICS. ANCILLARY SERVICES WERE PROVIDED AS FOLLOWS: 170,701 LAB TESTS; 6,852 RADIOLOGY TESTS; 4,074 RESPIRATORY THERAPY PROCEDURES; 25,090 MEALS TO PATIENTS, VISITORS, AND EMPLOYEES. THROUGHOUT THE YEAR THERE WERE 2,240 RHC NURSE VISITS. 24087098 1 1 0 0 0 0 0 0 1 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 1 0 0 0 0 0 1 0 0 0 1 71 0 1 303 1 0 0 0 0 0 0 0 0 0 0 0 0 X 9 7 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 CHARIS CAMPBELL CHAIRMAN & LIAISON TO WRHSF BOARD 1.00 X X 140 0 0 DR LISA HENDERSON VICE-CHAIRMAN 1.00 X X 170 0 0 LYNN BROWN SECRETARY/TREASURER 1.00 X X 100 0 0 JONATHON EATON REPRESENTATIVE 1.00 X 100 0 0 TROY MOSBRUCKER REPRESENTATIVE 1.00 X 50 0 0 DOUG PETERSON REPRESENTATIVE 1.00 X 60 0 0 KELLY PIERCE REPRESENTATIVE 1.00 X 90 0 0 CHARLIE REISENAUER REPRESENTATIVE 1.00 X 100 0 0 DR STEVEN KILWEIN MEDICAL STAFF LIASISON 40.00 X 253825 0 37950 ROGER GOODFELLOW FORMER REPRESENTATIVE 1.00 X 0 0 0 MATT SHAHAN CEO 36.00 4.00 X 210408 0 19058 NATHAN STADHEIM CFO 29.00 11.00 X 115259 0 32592 MARK KRISTY PHYSICIAN 40.00 X 286805 0 36282 KENT HOERAUF PHYSICIAN 40.00 X 290712 13200 30070 JOSHUA RANUM PHYSICIAN 40.00 X 292593 0 18768 CATHERINE SHIREK PHYSICIAN 40.00 X 276829 0 33594 CARRIE RANUM PHYSICIAN 40.00 X 206751 0 26945 1933992 13200 235259 16 0 1 0 DA PETERSON AND ASSOCIATES LLC 406 10TH ST WEST LEMMON SD 57638 CONTRACTOR SERVICES 1124446 NATIONAL MEDICAL RESOURCES 2792 E BROADWAY AVE BISMARCK ND 58501 PROFESSIONAL NURSING SERVICES 463911 CHRISTENSEN ANESTHESIA INC 802 11TH AVE NW HETTINGER ND 58639 PROFESSIONAL ANESTHESIA SERVICES 417061 HAYES HEALTHCARE LLC FKA HAYES LOCUMS LL 6700 NORTH ANDREWS AVE SUITE 600 FORT LAUDERDALE FL 33309 PROFESSIONAL NURSING SERVICES 346305 MEDICAL SOLUTIONS LLC DBA AUREUS NURSING 13609 CALIFORNIA ST OMAHA NE 68154 PROFESSIONAL NURSING SERVICES 172786 5 167430 178755 346185 PATIENT SERVICE REVENUE 621110 25994345 25994345 OTHER OPERATING REVENUE 900099 442496 442496 CAFETERIA 722514 71831 71831 ASSISTED LIVING BUILDING RENT 900002 57600 57600 26566272 62820 62820 38550 40 38510 38510 38510 9256 13119 -3863 -3863 -3863 RELATED-PARTY NOTE RECOVERY 900099 50000 50000 50000 27059924 26566272 0 147467 X 669902 291775 378127 11885200 11134523 666683 83994 383846 359891 21243 2712 1202245 1133052 60614 8579 833728 761685 66425 5618 20252 20252 42632 42632 3991320 3671513 319128 679 74957 74957 74720 70362 4018 340 499617 460528 37735 1354 110493 108576 1916 1 97012 79146 17861 5 6179 6179 1693461 1541639 149206 2616 291304 272265 18484 555 SUPPLIES - MEDICAL AND 3164734 3148771 15659 304 REPAIRS & MAINTENANCE 965075 559332 405682 61 OTHER MISCELLANEOUS EXP 292388 238333 53998 57 RECRUITMENT 184728 118751 65977 130777 130777 26614570 24087098 2420597 106875 2012363 2209279 3963891 3738980 643408 586601 362368 343074 37884751 26049889 12387394 11834862 3034031 4591460 317318 630999 22720773 23935255 1735080 1632441 372882 1244649 2107962 2877090 X 20612811 21058165 20612811 21058165 22720773 23935255 445354 0 X X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 1 11845 2283 14128 0 0 18000 90113 108113 1981026 20738301 13208700 9510627 36171 14005102 12237898 1803375 1016038 603291 412747 11834862 X 26929187 -130777 -130777 27059964 -40 -40 27059924 26483833 40 40 26483793 130777 130777 26614570 PART IV, LINE 1B: THE HOSPITAL HAS AN AUXILIARY THAT OPERATES UNDER THEIR EIN. THESE FUNDS ARE CONTROLLED BY THE AUXILIARY BOARD MEMBERS. THIS ACCOUNT WAS CLOSED DURING FY 2020. PART X, LINE 2: AS OF MARCH 31, 2020, 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 2017. 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 -130,777. PART XI, LINE 4B - OTHER ADJUSTMENTS: RENTAL EXPENSES -40. PART XII, LINE 2D - OTHER ADJUSTMENTS: RENTAL EXPENSES 40. PART XII, LINE 4B - OTHER ADJUSTMENTS: BAD DEBT EXPENSE 130,777. 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 181957 181957 0.00690 1682788 1188364 494424 0.01870 1864745 1188364 676381 0.02560 12964 3683 9281 0.00040 4569330 4385789 183541 0.00690 4582294 4389472 192822 0.00730 6447039 5577836 869203 0.03290 6564 6564 0.00020 243164 243164 0.00920 249728 249728 0.00940 1 130777 0 12941258 13598677 -657419 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 17 1 0 0 1 X HTTP://WWW.WRHS.COM X 1 17 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, A COMMUNITY MEETING TO DISCUSS HEALTH NEEDS AND THE ASSESSMENT PROCESS, 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. WEST RIVER HEALTH SERVICES PART V, SECTION B, LINE 11: THE TOP FIVE ISSUES IDENTIFIED AS PART OF THE ASSESSMENT PROCESS WERE OBESITY, AVAILABILITY OF SUBSTANCE ABUSE/TREATMENT SERVICES, CANCER, ATTRACTING AND RETAINING YOUNG FAMILIES, AND ADULT ALCOHOL USE AND ABUSE.IN AN EFFORT TO ADDRESS OBESITY, WRHS HAS ADDED AN IDEAL PROTEIN PROGRAM WHICH IS A KETOGENIC WEIGHT LOSS AND WEIGHT MANAGEMENT PROTOCOL. THIS PROGRAM IS A MEDICALLY DEVELOPED 4 PHASE PROTOCOL CONTAINING 2 KEY COMPONENTS - WEIGHT LOSS AND A HEALTHIER LIFESTYLE EDUCATION SO THAT PATIENTS ARE EMPOWERED TO SUSTAIN THEIR WEIGHT LOSS RESULTS OVER THEIR LIFE COURSE. IN ADDITION TO THIS WEIGHT-LOSS PROGRAM, WRHS CONTINUES TO OFFER NUTRITION EDUCATION ON AN INDIVIDUAL AND GROUP BASIS.TO BOLSTER AVAILABILITY OF BEHAVIORAL HEALTH SERVICES IN RESPONSE TO SEVERAL OF THE NEEDS IDENTIFIED, WRHS ADDED A FULL-TIME PSYCHIATRIC MENTAL HEALTH NURSE PRACTITIONER TO SERVE ALL AGES. WE BELIEVE THIS WILL ASSIST IN ADDRESSING SEVERAL OF THE NEEDS IDENTIFIED. WRHS IS ALSO RESEARCHING ALL REFERRAL AVENUES FOR SUBSTANCE ABUSE/TREATMENT SERVICES THAT ARE CURRENTLY AVAILABLE IN THE AREA. WHILE ADDING A SERVICE LINE TO HELP IN ADDRESSING THIS IS NOT COMPLETELY OUT OF THE QUESTION, WE BELIEVE THE SERVICES ARE AVAILABLE BUT NOT BEING UTILIZED TO THEIR FULL EXTENT AT THIS TIME.WRHS IS CONSIDERING WAYS IT CAN HELP IN ADDRESSING CANCER CONCERNS. CERTAINLY CANCER HAS IMPACTED NEARLY ALL OF THE RESIDENTS OF OUR SERVICE AREA IN ONE WAY OR ANOTHER. WHILE THIS ORGANIZATION IS NOT EQUIPPED WITH THE RESOURCES TO RESEARCH A CURE, WE BELIEVE IT MAY BE POSSIBLE TO OFFER MORE TREATMENT SERVICES CLOSER TO OUR PATIENTS' HOMES. CURRENTLY, MANY OF THE TREATMENTS ARE RECEIVED 150 MILES AWAY. THROUGH COLLABORATIVE AGREEMENTS, WE BELIEVE THERE MAY BE WAYS TO PROVIDE SOME OF THOSE SERVICES HERE. FINDING A PARTNER HAS BEEN DIFFICULT UP TO THIS POINT BUT WE CONTINUE TO MEET WITH ALL POTENTIAL PARTNERS. 2 1 - WEST RIVER EYE CENTER 1000 HWY 12 HETTINGER ND 58639 CLINIC 2 - WEST RIVER FOOT & ANKLE CENTER 683 STATE AVENUE SUITE E DICKINSON ND 58601 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 $ 130,777. 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. THE SCRUBS CAMP HELD ANNUALLY IS DESIGNED TO INTRODUCE YOUNG ADULTS TO THE POTENTIAL HEALTHCARE CAREERS THAT ARE AVAILABLE RIGHT HERE AT HOME. PART III, LINE 2: THE FOOTNOTE TO THE ORGANIZATION'S FINANCIAL STATEMENTS CAN BE FOUND ON PAGE 13 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 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, DICKINSON, 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 DR STEVEN KILWEIN MEDICAL STAFF LIASISON 253825 0 0 0 0 0 7855 0 30095 0 291775 0 0 0 MATT SHAHAN CEO 198444 0 11964 0 0 0 6431 0 12627 0 229466 0 0 0 MARK KRISTY PHYSICIAN 286805 0 0 0 0 0 8400 0 27882 0 323087 0 0 0 KENT HOERAUF PHYSICIAN 290712 13200 0 0 0 0 8400 0 21670 0 320782 13200 0 0 JOSHUA RANUM PHYSICIAN 292593 0 0 0 0 0 8400 0 10368 0 311361 0 0 0 CATHERINE SHIREK PHYSICIAN 276829 0 0 0 0 0 8305 0 25289 0 310423 0 0 0 CARRIE RANUM PHYSICIAN 206751 0 0 0 0 0 6203 0 20742 0 233696 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 77360 COMPENSATION 0 KYLEE STADHEIM SPOUSE OF NATHAN STADHEIM, CFO 19197 COMPENSATION 0 KIM SCHALESKY DAUGHTER OF LONNIE STIPPICH (WRHSF [RELATED PARTY] BOARD DIRECTOR) 36977 COMPENSATION 0 DA PETERSON & ASSOCIATES OWNED BY DOUG PETERSON, A WRHS BOARD MEMBER 1124446 LEMMON CLINIC CONTRACTOR 0 FORM 990, PART VI, SECTION A, LINE 1 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 3,671,513. MANAGEMENT AND GENERAL EXPENSES 319,128. FUNDRAISING EXPENSES 679. TOTAL EXPENSES 3,991,320. 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 1 1 1 0 0 0 0 0 1 0 0 0 0 0 1 1 0 0 WESTERN HORIZONS LIVING CENTER B 547 CASH PAID WEST RIVER HEALTH SERVICES FOUNDATION C 167430 CASH PAID WEST RIVER HEALTH SERVICES FOUNDATION D 22290 CASH PAID WESTERN HORIZONS LIVING CENTER D 151406 CASH PAID WESTERN HORIZONS LIVING CENTER J 57600 LEASE AGREEMENT WESTERN HORIZONS LIVING CENTER P 231 CASH PAID WEST RIVER HEALTH SERVICES FOUNDATION Q 135690 CASH PAID WESTERN HORIZONS LIVING CENTER Q 62498 CASH PAID