2019-02-11T16:34:51-06:00 2018-03-31 460403496 CASEY PETERSON LTD 909 ST JOSEPH ST SUITE 101 RAPID CITY SD 57701 990 2017-04-01 260794602 WESTERN HORIZONS LIVING CENTERS WEST 7015674561 1000 HIGHWAY 12 HETTINGER ND 58639 NATHAN STADHEIM CFO 7015674561 2019-02-11 1 DEIDRE BUDAHL CPA P01273830 6053481930 2019-02-11 65.153.235.186 2019-02-11 16:26:38 MS P DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 F816B9D621AD14857E56F1346500FC3E34F8C907 2017 2019-02-21 02:37:17Z MATT SHAHAN 1000 HIGHWAY 12 HETTINGER ND 58639 3703178 0 X WWW.WRHS.COM X 2007 ND TO ASSIST OUR NEIGHBORS IN ACHIEVING AND MAINTAINING THEIR HIGHEST LEVEL OF INDEPENDENCE. 11 10 88 0 0 0 200297 37192 3984157 3665986 0 -5534 60411 0 4244865 3697644 0 0 0 0 2618105 2295713 0 0 0 1543644 1993095 4161749 4288808 83116 -591164 1021806 1037570 2167659 2774587 -1145853 -1737017 X THE MISSION OF WESTERN HORIZONS LIVING CENTERS IS TO ASSIST OUR NEIGHBORS IN ACHIEVING AND MAINTAINING THEIR HIGHEST LEVEL OF INDEPENDENCE IN A CARING AND RESPECTFUL ENVIRONMENT. 0 0 3167893 3191509 WESTERN HORIZONS LIVING CENTERS (WHLC) OPERATES A 48 BED SKILLED NURSING FACILITY. IN ADDITION TO THE BASIC DAILY ROUTINE CARE, STAFF ALSO PROVIDE PHYSICAL THERAPY, OCCUPATIONAL THERAPY, SPEECH THERAPY, ACTIVITIES, AND SOCIAL SERVICES TO THE RESIDENTS. ON AVERAGE, LONG-TERM CARE SERVICES WERE PROVIDED TO 41 RESIDENTS FOR THIS REPORTING PERIOD. THERE WERE 15,001 SKILLED NURSING DAYS WITH ABOUT 53% OF THOSE DAYS BEING MEDICAID CERTIFIED. THROUGHOUT THE YEAR, WHLC AND COMMUNITY INDIVIDUALS/GROUPS PROVIDED MANY VARIED FORMS OF PROGRAMMING, INCLUDING EXERCISE GROUPS, MUSICAL ENTERTAINMENT, BINGO, VAN TRIPS, COMMUNITY OUTINGS, SOCIAL EVENTS, MONTHLY BIRTHDAY PARTIES, EDUCATIONAL PROGRAMS, MOVIES AND BEDSIDE ACTIVITIES. LOCAL CLERGY AND FACILITY STAFF CONDUCTED REGULAR WORSHIP SERVICES AND BIBLE STUDIES FOR RESIDENTS. A GROUP OF LOCAL LADIES WEEKLY VOLUNTEER THEIR SERVICES IN HAIRDRESSING FOR THE RESIDENTS. 462560 466008 IN ADDITION TO THE SKILLED NURSING FACILITY, WHLC OPERATED 16-UNIT ASSISTED LIVING FACILITY KNOWN AS WESTERN HORIZONS ASSISTED LIVING (WHAL). IT PROVIDES HANDICAP ACCESSIBLE BATHROOMS IN THE ROOMS, ELECTRIC DOOR OPENERS THROUGHOUT THE FACILITY, AND IS ALL ON ONE LEVEL TO PROVIDE EASY ACCESSIBILITY TO THE TENANTS. WHAL OPERATES CHARITABLY BY MEETING THE PHYSICAL, EMOTIONAL, RECREATIONAL, SOCIAL, RELIGIOUS, AND SIMILAR NEEDS OF ELDERLY PEOPLE. SOME OF THE ACTIVITIES INCLUDE CARD PLAYING, GARDENING, WEEKLY RELIGIOUS GATHERINGS, AND SOCIAL INTERACTION WITH EACH OTHER OR FAMILY VISITORS. STAFF ALSO PROVIDES OTHER HEALTH-RELATED SERVICES INCLUDING BATHING, HAIR, SKIN AND NAIL CARE, DRESSING, ASSISTANCE WITH MOBILITY, COMMUNICATION AND REMINDERS, MEDICATION MANAGEMENT, HOUSEKEEPING AND LAUNDRY SERVICES, MEAL PLANNING AND PREPARATION, EXERCISE PROGRAM, AND MONITORING BLOOD SUGARS, VITAL SIGNS AND OXYGEN. WHILE THERE HAS BEEN SOME TURNOVER THROUGHOUT THE YEAR DUE TO DEATH AND/OR THE TENANT NEEDING A HIGHER LEVEL OF CARE, WHAL HAS ENJOYED A VERY HIGH OCCUPANCY RATE AND HAS A WAITING LIST OF THOSE SEEKING ASSISTED LIVING SERVICES. ASSISTED LIVING SERVICES ARE OPEN TO ANY INDIVIDUAL WHO QUALIFIES FOR CARE. STAFF HAVE CLOSE RELATIONSHIPS WITH REGIONAL AND COUNTY SOCIAL SERVICE WORKERS TO ASSIST IN THE APPLICATION PROCESS FOR MEDICAL ASSISTANCE IF THE NEED ARISES. 3630453 1 1 0 0 0 0 0 0 1 0 1 0 0 0 1 1 1 1 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 23 0 1 88 1 0 0 0 0 0 0 0 0 0 0 X 11 10 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 0 0 0 ND X NATHAN STADHEIM 7015674561 1000 HIGHWAY 12 HETTINGER ND 58369 TERRY HENDERSON CHAIRMAN 1.00 X X 0 0 0 KATHY VLIEM VICE-CHAIRMAN 1.00 X X 0 0 0 LINDA WEAVER SECRETARY/TREASURER 1.00 X X 0 0 0 BLANE CHAPMAN REPRESENTATIVE 1.00 X 0 0 0 STEVE HEDSTROM REPRESENTATIVE 1.00 X 0 0 0 DR KENT HEORAUF MEDICAL LIASON 2.00 40.00 X 13200 151234 21793 BETTYNA JOHNSON REPRESENTATIVE 1.00 X 0 0 0 STEVE MCFARLAND REPRESENTATIVE 1.00 X 0 0 0 ALLEN MCINTYRE REPRESENTATIVE 1.00 X 0 0 0 ROBERT PARKER REPRESENTATIVE 1.00 X 0 0 0 SETH SKOGEN REPRESENTATIVE 1.00 X 0 0 0 MATT SHAHAN PRESIDENT, CEO 11.00 29.00 X 0 178231 11277 NATHAN STADHEIM CFO 7.00 33.00 X 0 97404 16835 13200 426869 49905 0 0 1 0 WEST RIVER REGIONAL MEDICAL CENTER 1000 HIGHWAY 12 HETTINGER ND 58639 STAFFING & HEALTHCARE SERVICES, MANAGEME 256965 PRIME TIME HEALTHCARE LLC PO BOX 3544 OMAHA NE 68103 AGENCY NURSING STAFF 256518 DAKOTA TRAVEL NURSE INC 1200 COLLINS AVE MANDAN ND 58554 AGENCY NURSING STAFF 151600 GUARDIAN HEALTHCARE PROVIDERS 105 WESTPARK DRIVE SUITE 100 BRENTWOOD TN 370275062 AGENCY NURSING STAFF 101668 4 25888 11304 9291 37192 RESIDENT SERVICE REVEN 623000 3191509 3191509 ASSISTED LIVING REVENU 623000 466008 466008 MISCELLANEOUS REVENUE 900099 8469 8469 3665986 5534 -5534 -5534 -5534 3697644 3657517 0 2935 X 13200 13200 1796814 1743782 53032 45117 42075 3042 314221 304294 9927 126361 120808 5553 101894 101894 35650 35650 18752 18752 841882 759567 82315 1058 1058 6865 6865 32610 32610 214360 198706 15654 12167 6551 5616 14030 14030 119477 119477 27580 18042 9538 SUPPLIES- MEDICAL & OTH 241910 238742 3168 MEDICARE PENALTY FEES 192705 192705 BAD DEBT EXPENSE 44105 44105 MAINTENANCE 31917 31496 421 56133 32883 23250 4288808 3630453 658355 0 27517 67813 257173 309994 18961 14173 12438 8786 2451775 1814971 705717 636804 1021806 1037570 230656 286164 391808 325286 25188 22358 55344 418673 1464663 1722106 2167659 2774587 X -1145853 -1737017 -1145853 -1737017 1021806 1037570 -591164 0 X X 0 1 X 1 0 X 88766 59696 32116 200297 37192 418067 3913771 4034326 4004819 3984157 3665986 19603059 2356 2356 4004893 4094022 4036935 4184454 3703178 20023482 0 128489 222374 319490 404371 541699 1616423 128489 222374 319490 404371 541699 1616423 18407059 4004893 4094022 4036935 4184454 3703178 20023482 0.91930 0.91520 0.00000 X 0 1 X 122647 122647 1657498 1245396 412102 609569 516942 92627 62061 52633 9428 636804 DUE TO RELATED PARTY 279651 NOTE PAYABLE TO WEST RIVER HEALTH SERVICES FOUNDATION 600000 NOTE PAYABLE TO WEST RIVER HEALTH SERVICES 650000 PENALTY PAYABLE TO MEDICARE 192455 1722106 X 3697644 0 3697644 0 3697644 4288808 0 4288808 0 4288808 PART IV, LINE 2B: WESTERN HORIZONS LIVING CENTERS ACT AS CUSTODIAN FOR THE FUNDS OF THE NURSING FACILITY RESIDENTS AND HOLDS SECURITY DEPOSITS FOR RESIDENTS OF THE ASSISTED LIVING FACILITIES. THESE FUNDS ARE INCLUDED IN CASH AND ACCOUNTS PAYABLE IN THE FINANCIAL STATEMENTS. RESIDENT TRUST FUNDS AND SECURITY DEPOSITS TOTALED $25,188 AND $22,358 AT MARCH 31, 2017 AND 2018. PART X, LINE 2: AS OF MARCH 31, 2018, WHLC HAD NO UNCERTAIN TAX POSITIONS THAT QUALIFY FOR EITHER RECOGNITION OR DISCLOSURE IN THE FINANCIAL STATEMENTS. WHLC'S INCOME TAX FILINGS ARE SUBJECT TO AUDIT BY VARIOUS TAXING AUTHORITIES. WHLC IS NO LONGER SUBJECT TO FEDERAL AND STATE INCOME TAX EXAMINATIONS BY TAXING AUTHORITIES FOR FISCAL YEARS BEFORE 2014. MANAGEMENT CONTINUALLY EVALUATES EXPIRING STATUTES OF LIMITATION, AUDITS, PROPOSED SETTLEMENTS, CHANGES IN TAX LAW AND NEW AUTHORITATIVE RULINGS. WHLC 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. 0 0 0 0 0 0 0 0 0 DR KENT HEORAUF MEDICAL LIASON 13200 151234 0 0 0 0 0 4770 0 17023 13200 173027 0 0 MATT SHAHAN PRESIDENT, CEO 0 178231 0 0 0 0 0 5497 0 5780 0 189508 0 0 PART I, LINE 3 THE ORGANIZATION'S CEO IS COMPENSATED BY WEST RIVER HEALTH SERVICES (A RELATED PARTY). 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. A CITY OF HETTINGER NORTH DAKOTA 456002094 2007-12-03 900000 PURCHASE OF NURSING HOME AND EQUIPMENT 0 0 0 A 574714 900000 900000 2007 1 0 1 1 A 0 0 0 0 0 0 0 A 0 0 1 0 1 0 0 0 0 A 0 FORM 990, PART VI, SECTION A, LINE 1 THE EXECUTIVE COMMITTEE CAN ACT FOR AND ON BEHALF OF THE FULL BOARD. IT IS COMPRISED OF THE CHAIR, VICE CHAIR, SECRETARY/TREASURER, PAST CHAIR, MEDICAL STAFF REPRESENTATIVE, AND ONE ADDITIONAL MEMBER OF THE WESTERN HORIZONS LIVING CENTER BOARD. FORM 990, PART VI, SECTION A, LINE 6 WEST RIVER HEALTH SERVICES FOUNDATION IS THE SOLE MEMBER. FORM 990, PART VI, SECTION A, LINE 7A AS THE SOLE MEMBER, WEST RIVER HEALTH SERVICES FOUNDATION ELECTS THE BOARD OF DIRECTORS. FORM 990, PART VI, SECTION A, LINE 7B THE FOLLOWING ACTIONS OF THE BOARD OF DIRECTORS REQUIRE APPROVAL BY THE WEST RIVER HEALTH SERVICES FOUNDATION: 1) CHANGES TO THE ARTICLES OF INCORPORATION OR BYLAWS; 2) DEBT IN EXCESS OF SET LIMITS; 3) DISSOLUTION OR MERGER OF THE CORPORATION; 4) SALE OR TRANSFER OF ANY CAPITAL ASSESTS WITH A PURCHASE PRICE OR FAIR 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. BOARD MEMBERS WITH CONFLICTS ABSTAIN FROM VOTING, AND THIS ACTION IS NOTED IN BOARD MINUTES. FORM 990, PART VI, SECTION B, LINE 15 EACH BOARD AND MEDICAL STAFF MEMBER ANNUALLY COMPLETES AN EVALUATION FORM ON THE ADMINISTRATOR'S PERFORMANCE; THE CHAIRMAN OF THE EXECUTIVE COMMITTEE TABULATES THE RESULTS AND REVIEWS WITH THE MEMBERS OF THE EXECUTIVE COMMITTEE; RESULTS ARE PRESENTED TO THE FULL BOARD OF DIRECTORS WHO HAVE FINAL AUTHORITY IN DETERMINING COMPENSATION. COMPARABILITY DATA FROM THE ND LONG TERM CARE ASSOCIATION, AS WELL AS OTHER COMPARATIVE INDUSTRY INFORMATION, IS USED IN DETERMINING COMPENSATION. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990, PART IX, LINE 11G CONTRACTED SERVICES: PROGRAM SERVICE EXPENSES 759,567. MANAGEMENT AND GENERAL EXPENSES 82,315. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 841,882. FORM 990, PART XII, LINE 2C: THE BOARD OF DIRECTORS IS RESPONSIBLE FOR THE OVERSIGHT OF THE AUDIT. THIS PROCESS HAS NOT CHANGED FROM PREVIOUS YEARS. WEST RIVER HEALTH SERVICES 1000 HWY 12 HETTINGER ND 58639 450340688 HOSPITAL ND 501C3 LINE 3 WEST RIVER HEALTH SERVICES FOUNDATION 0 WEST RIVER HEALTH SERVICES FOUNDATION 1000 HWY 12 HETTINGER ND 58639 450411825 FUNDRAISING ND 501C3 LINE 11C, III-FI 0 0 0 1 0 1 0 0 0 0 0 1 0 0 0 0 1 1 0 0 WEST RIVER HEALTH SERVICES FOUNDATION C 25888 CASH PAID WEST RIVER HEALTH SERVICES E 895393 CASH PAID WEST RIVER HEALTH SERVICES FOUNDATION E 634356 CASH PAID WEST RIVER HEALTH SERVICES P 140856 CASH PAID WEST RIVER HEALTH SERVICES K 74850 LEASE AGREEMENT WEST RIVER HEALTH SERVICES Q 578 CASH PAID