WEST RIVER HEALTH SERVICES: Form 990, tax year 2012
View the entire original 990 at ProPublica ↗
- Organization
- WEST RIVER HEALTH SERVICES (EIN 45-0340688)
- Tax period
- 2012-04-01 to 2013-03-31
- Filed
- 2014-01-30
- IRS object ID
- 201440309349300904
- Schema version
- 2012v2.1
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
- Return header
- Form 990
- Schedule A
- Schedule B
- Schedule D
- Schedule H
- Schedule J
- Schedule K
- Schedule L
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Timestamp | 2014-01-30T16:18:35-06:00 | Timestamp |
| Tax Period End Date | 2013-03-31 | TaxPeriodEndDate |
Preparer Firm PreparerFirm
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 450250958 | EIN |
Preparer Firm Business Name PreparerFirmBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | EIDE BAILLY LLP | BusinessNameLine1 |
Preparer Firm US Address PreparerFirmUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 4310 17TH AVE S PO BOX 2545 | AddressLine1 |
| City | FARGO | City |
| State | ND | State |
| ZIP Code | 581082545 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnType |
| Tax Period Begin Date | 2012-04-01 | TaxPeriodBeginDate |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 450340688 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | West River Health Services | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Control | WEST | NameControl |
| Phone | 7015674561 | Phone |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1000 Highway 12 | AddressLine1 |
| City | Hettinger | City |
| State | ND | State |
| ZIP Code | 58639 | ZIPCode |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | Jim K Long | Name |
| Title | CEO | Title |
| Phone | 7015674561 | Phone |
| Date Signed | 2014-01-28 | DateSigned |
| Authorize Third Party | 1 | AuthorizeThirdParty |
Preparer Preparer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | LISA CHAFFEE CPA | Name |
| PTIN | P00193453 | PTIN |
| Phone | 7012398500 | Phone |
| Date Prepared | 2014-01-28 | DatePrepared |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax Year | 2012 | TaxYear |
| Build TS | 2015-11-30 17:44:51Z | BuildTS |
Form 990 IRS990
Doing Business As DoingBusinessAs
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | West River Regional Medical Center | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Principal Officer Person | Jim K Long | NameOfPrincipalOfficerPerson |
Address Principal Officer US AddressPrincipalOfficerUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1000 Highway 12 | AddressLine1 |
| City | Hettinger | City |
| State | ND | State |
| ZIP Code | 58639 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | 25161545 | GrossReceipts |
| Group Return For Affiliates | 0 | GroupReturnForAffiliates |
| Organization501c3 | X | Organization501c3 |
| Web Site | www.wrhs.com | WebSite |
| Type Of Organization Corporation | X | TypeOfOrganizationCorporation |
| Year Formation | 1977 | YearFormation |
| State Legal Domicile | ND | StateLegalDomicile |
| Activity Or Mission Description | Provide comprehensive health and wellness services to the residents and visitors of the region. | ActivityOrMissionDescription |
| Nbr Voting Members Governing Body | 11 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 9 | NbrIndependentVotingMembers |
| Total Nbr Employees | 317 | TotalNbrEmployees |
| Total Nbr Volunteers | 0 | TotalNbrVolunteers |
| Total Gross UBI | 0 | TotalGrossUBI |
| Net Unrelated Business Txbl Income | 0 | NetUnrelatedBusinessTxblIncome |
| Contributions Grants Prior Year | 1680639 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 638092 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 23873368 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 24390118 | ProgramServiceRevenueCY |
| Investment Income Prior Year | 61464 | InvestmentIncomePriorYear |
| Investment Income Current Year | 69415 | InvestmentIncomeCurrentYear |
| Other Revenue Prior Year | 53775 | OtherRevenuePriorYear |
| Other Revenue Current Year | 55770 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 25669246 | TotalRevenuePriorYear |
| Total Revenue Current Year | 25153395 | TotalRevenueCurrentYear |
| Grants And Similar Amnts Prior Year | 6137 | GrantsAndSimilarAmntsPriorYear |
| Grants And Similar Amnts CY | 2044 | GrantsAndSimilarAmntsCY |
| Benefits Paid To Members Prior Year | 0 | BenefitsPaidToMembersPriorYear |
| Benefits Paid To Members CY | 0 | BenefitsPaidToMembersCY |
| Salaries Etc Prior Year | 10288219 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 10659915 | SalariesEtcCurrentYear |
| Total Prof Fundrsng Exp Prior Year | 0 | TotalProfFundrsngExpPriorYear |
| Total Prof Fundrsng Exp CY | 0 | TotalProfFundrsngExpCY |
| Total Fundrsng Exp Current Year | 79800 | TotalFundrsngExpCurrentYear |
| Other Expense Prior Year | 13575766 | OtherExpensePriorYear |
| Other Expenses Current Year | 13786171 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 23870122 | TotalExpensesPriorYear |
| Total Expenses Current Year | 24448130 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | 1799124 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | 705265 | RevenuesLessExpensesCY |
| Total Assets BOY | 26847556 | TotalAssetsBOY |
| Total Assets EOY | 26931485 | TotalAssetsEOY |
| Total Liabilities BOY | 8549839 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 7900868 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | 18297717 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 19030617 | NetAssetsOrFundBalancesEOY |
| Info In Schedule O Part III | X | InfoInScheduleOPartIII |
| Mission Description | The mission of West River Health Services (WRHS) is to provide comprehensive health and wellness services to the residents and visitors of the region. | MissionDescription |
| Significant New Program Services | 0 | SignificantNewProgramServices |
| Significant Change | 0 | SignificantChange |
| Expense | 23018126 | Expense |
| Grants | 2044 | Grants |
| Revenue | 24412288 | Revenue |
| Description | 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 2013, WRHS provided acute care services to 955 patients for a total of 3637 days of care. Swing bed services were provided to 93 patients for a total of 741 days of care. In addition, 711 days of observation care were provided. There were 1,683 emergency room visits during the year. There were 110 babies born during the year with a total of 238 days of care provided. There were a total of 931 surgical cases during the year, with 766 of those being done on an outpatient basis. The ambulance crew made 234 ambulance runs/transfers throughout the year. There were 41,261 clinic encounters to the seven clinics. Ancillary services were provided as follows: 191,236 lab tests; 10,285 radiology tests; 8,469 respiratory therapy tests; 36,145 meals to patients, visitors, and employees. Throughout the year, there were 1,694 RHC nurse visits. It is the policy of the WRHS to provide quality health care services to all patients in the region regardless of race, color, creed or ability to pay. To this end, WRHS offers free and discounted services to patients who lack ability to pay. The WRHS Charity Care Policy, initially approved in June of 2006 and revised in 2011, assures that all eligible patients will receive the care they deserve without financial worry. The Finance Committee of the Board of Directors has oversight of the Charity Care Program, approves eligibility criteria, and evaluates program effectiveness. The amount of charity care provided in FY '13 for eligible individuals was $157,778. This amount reflects the amount of charges foregone based on established rates. | Description |
| Total Program Service Expense | 23018126 | TotalProgramServiceExpense |
| Described In501 C3 | 1 | DescribedIn501C3 |
| Schedule B Required | 1 | ScheduleBRequired |
| Political Activities | 0 | PoliticalActivities |
| Lobbying Activities | 0 | LobbyingActivities |
| Subject To Proxy Tax | 0 | SubjectToProxyTax |
| Donor Advised Funds | 0 | DonorAdvisedFunds |
| Conservation Easements | 0 | ConservationEasements |
| Collections Of Art | 0 | CollectionsOfArt |
| Credit Counseling | 1 | CreditCounseling |
| Term Or Permanent Endowments | 0 | TermOrPermanentEndowments |
| Report Land Bldg Equip | 1 | ReportLandBldgEquip |
| Report Invest Oth Securities | 0 | ReportInvestOthSecurities |
| Report Prog Rel Invest | 0 | ReportProgRelInvest |
| Report Other Assets | 1 | ReportOtherAssets |
| Report Other Liabilities | 1 | ReportOtherLiabilities |
| Report Fin48 Footnote | 1 | ReportFin48Footnote |
| Independent Audit Financial Stmt | 1 | IndependentAuditFinancialStmt |
| Consolidated Audit Financial Stmt | 1 | ConsolidatedAuditFinancialStmt |
| School | 0 | School |
| Foreign Office | 0 | ForeignOffice |
| Foreign Activities | 0 | ForeignActivities |
| More Than5000 K To Organizations | 0 | MoreThan5000KToOrganizations |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividuals |
| Professional Fundraising | 0 | ProfessionalFundraising |
| Fundraising Activities | 0 | FundraisingActivities |
| Gaming | 0 | Gaming |
| Hospital | 1 | Hospital |
| Financial Stmt Attached | 1 | FinancialStmtAttached |
| Grants To Organizations | 0 | GrantsToOrganizations |
| Grants To Individuals | 0 | GrantsToIndividuals |
| Schedule J Required | 1 | ScheduleJRequired |
| Tax Exempt Bonds | 1 | TaxExemptBonds |
| Invest Tax Exempt Bonds | 0 | InvestTaxExemptBonds |
| Escrow Account | 0 | EscrowAccount |
| On Behalf Of Issuer | 0 | OnBehalfOfIssuer |
| Excess Benefit Transaction | 0 | ExcessBenefitTransaction |
| Prior Excess Benefit Transaction | 0 | PriorExcessBenefitTransaction |
| Loan To Officer Or DQP | 0 | LoanToOfficerOrDQP |
| Grant To Related Person | 0 | GrantToRelatedPerson |
| Bsnss Rltnshp With Organization | 0 | BsnssRltnshpWithOrganization |
| Bsnss Rltnshp Thru Family Member | 1 | BsnssRltnshpThruFamilyMember |
| Officer Entity With Bsnss Rltnshp | 0 | OfficerEntityWithBsnssRltnshp |
| Deductible Non Cash Contributions | 0 | DeductibleNonCashContributions |
| Deductible Contributions Of Art | 0 | DeductibleContributionsOfArt |
| Terminated | 0 | Terminated |
| Partial Liquidation | 0 | PartialLiquidation |
| Disregarded Entity | 0 | DisregardedEntity |
| Related Entity | 1 | RelatedEntity |
| Related Org Controlled Entity | 0 | RelatedOrgControlledEntity |
| Transfers To Exempt Non Chrtbl Org | 0 | TransfersToExemptNonChrtblOrg |
| Activities Conducted Partnership | 0 | ActivitiesConductedPartnership |
| Schedule O Required | 1 | ScheduleORequired |
| Number Forms Transmitted With1096 | 27 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Compliance With Backup Witholding | 1 | ComplianceWithBackupWitholding |
| Number Of Employees | 317 | NumberOfEmployees |
| Employment Tax Returns Filed | 1 | EmploymentTaxReturnsFiled |
| Unrelated Business Income | 0 | UnrelatedBusinessIncome |
| Foreign Financial Account | 0 | ForeignFinancialAccount |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTrans |
| Taxable Party Notification | 0 | TaxablePartyNotification |
| Non Deductible Contributions | 0 | NonDeductibleContributions |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributions |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOf |
| Funds To Pay Premiums | 0 | FundsToPayPremiums |
| Premiums Paid | 0 | PremiumsPaid |
| Indoor Tanning Services | 0 | IndoorTanningServices |
| Info In Schedule O Part VI | X | InfoInScheduleOPartVI |
| Nbr Voting Governing Body Members | 11 | NbrVotingGoverningBodyMembers |
| Number Independent Voting Members | 9 | NumberIndependentVotingMembers |
| Family Or Business Relationship | 0 | FamilyOrBusinessRelationship |
| Delegation Of Management Duties | 0 | DelegationOfManagementDuties |
| Changes To Organizing Docs | 0 | ChangesToOrganizingDocs |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuse |
| Members Or Stockholders | 1 | MembersOrStockholders |
| Election Of Board Members | 1 | ElectionOfBoardMembers |
| Decisions Subject To Approval | 1 | DecisionsSubjectToApproval |
| Minutes Of Governing Body | 1 | MinutesOfGoverningBody |
| Minutes Of Committees | 1 | MinutesOfCommittees |
| Officer Mailing Address | 0 | OfficerMailingAddress |
| Local Chapters | 0 | LocalChapters |
| Form990 Provided To Governing Body | 1 | Form990ProvidedToGoverningBody |
| Conflict Of Interest Policy | 1 | ConflictOfInterestPolicy |
| Annual Disclosure Covered Persons | 1 | AnnualDisclosureCoveredPersons |
| Regular Monitoring Enforcement | 1 | RegularMonitoringEnforcement |
| Whistleblower Policy | 1 | WhistleblowerPolicy |
| Document Retention Policy | 1 | DocumentRetentionPolicy |
| Compensation Process CEO | 1 | CompensationProcessCEO |
| Compensation Process Other | 0 | CompensationProcessOther |
| Investment In Joint Venture | 0 | InvestmentInJointVenture |
| Upon Request | X | UponRequest |
The Books Are In Care Of TheBooksAreInCareOf
Name Business NameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Nathan Stadheim | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Telephone Number | 7015676150 | TelephoneNumber |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1000 Highway 12 | AddressLine1 |
| City | Hettinger | City |
| State | ND | State |
| ZIP Code | 58639 | ZIPCode |
Form990 Part VII Section A Form990PartVIISectionA (17 entries)
| TitleTitle | Average Hours Per WeekAverageHoursPerWeek | Individual Trustee Or DirectorIndividualTrusteeOrDirector | OfficerOfficer | Reportable Comp From OrganizationReportableCompFromOrganization | Reportable Comp From Related OrgsReportableCompFromRelatedOrgs | Other CompensationOtherCompensation | Average Hours Per Week RelatedAverageHoursPerWeekRelated | Highest Compensated EmployeeHighestCompensatedEmployee |
|---|---|---|---|---|---|---|---|---|
| Cody Jorgenson | ||||||||
| Chair | 2.00 | X | X | 510 | 0 | 0 | ||
| Eric Andress | ||||||||
| Vice Chair | 2.00 | X | X | 270 | 0 | 0 | ||
| Haley Evans | ||||||||
| Secretary/Treasurer | 2.00 | X | X | 180 | 0 | 0 | ||
| Gary Dewhirst | ||||||||
| Board Director | 2.00 | X | 350 | 0 | 0 | |||
| Ervin Schneider | ||||||||
| Board Director (Oct-Mar) | 2.00 | X | 20 | 0 | 0 | |||
| Cleve Teske | ||||||||
| Board Director | 2.00 | X | 190 | 0 | 0 | |||
| Robert Parker | ||||||||
| Board Director | 2.00 | X | 220 | 0 | 0 | |||
| Larry Jackson | ||||||||
| Board Director | 2.00 | X | 260 | 0 | 0 | 1.00 | ||
| Dr Steven Kilwien | ||||||||
| Board Director | 2.00 | X | 0 | 0 | 0 | |||
| Travis Ellison | ||||||||
| Board Director | 2.00 | X | 220 | 0 | 0 | |||
| Jonathan Eaton | ||||||||
| Board Director | 2.00 | X | 170 | 0 | 0 | |||
| Dale Wegh | ||||||||
| Board Director (Apr-Sept) | 2.00 | X | 100 | 0 | 0 | |||
| Jim Long | ||||||||
| CEO | 36.00 | X | 152558 | 0 | 19305 | 4.00 | ||
| Nathan Stadheim | ||||||||
| CFO (Oct-Mar) | 31.00 | X | 21446 | 0 | 1667 | 9.00 | ||
| Karan Ehlers | ||||||||
| CFO (Apr-Oct) | 27.00 | X | 85078 | 0 | 20081 | 13.00 | ||
| Susan Hallen | ||||||||
| Pharmacist | 40.00 | 152779 | 0 | 11471 | X | |||
| Mitch Schultz | ||||||||
| Pharmacist | 40.00 | 110695 | 0 | 21273 | X | |||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 525046 | TotalReportableCompFromOrg |
| Total Reportable Comp Frm Rltd Orgs | 0 | TotalReportableCompFrmRltdOrgs |
| Total Other Compensation | 73797 | TotalOtherCompensation |
| Number Individuals GT100 K | 3 | NumberIndividualsGT100K |
| Formers Listed | 0 | FormersListed |
| Total Comp GT150 K | 1 | TotalCompGT150K |
| Compensation From Other Sources | 0 | CompensationFromOtherSources |
Contractor Compensation ContractorCompensation (5 entries)
| Address Line1AddressOfContractor/AddressUS/AddressLine1 | CityAddressOfContractor/AddressUS/City | StateAddressOfContractor/AddressUS/State | ZIP CodeAddressOfContractor/AddressUS/ZIPCode | Description Of ServicesDescriptionOfServices | CompensationCompensation |
|---|---|---|---|---|---|
| United Clinics Physician PC | |||||
| 1100 Highway 12 | Hettinger | ND | 58639 | Physician Services | 4071676 |
| Dr Mark Kristy | |||||
| 1000 Highway 12 | Hettinger | ND | 58639 | Radiology Services | 333536 |
| Mondak Imaging Services | |||||
| 11 South 7th St Suite 241 | Miles City | MT | 59301 | MRI Services | 213273 |
| Medical Information Technology Inc | |||||
| PO Box 74569 | Chicago | IL | 60696 | Software Maintenance | 166515 |
| Alex or Kathleen Thompson | |||||
| 600 2nd Ave N | Hettinger | ND | 58639 | Physical Therapy Services | 149973 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Contractors GT100 K | 8 | NumberOfContractorsGT100K |
| Related Organizations | 29042 | RelatedOrganizations |
| Government Grants | 16141 | GovernmentGrants |
| All Other Contributions | 592909 | AllOtherContributions |
| Total Contributions | 638092 | TotalContributions |
Program Service Revenue ProgramServiceRevenue (5 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome |
|---|---|---|---|
| Patient Service Revenue | 621110 | 23483083 | 23483083 |
| Other | 900099 | 401962 | 401962 |
| Affiliation Support | 900099 | 300000 | 300000 |
| Assisted Living Rent | 621610 | 106975 | 106975 |
| Cafeteria | 722210 | 98098 | 98098 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | 24390118 | TotalProgramServiceRevenue |
Investment Income InvestmentIncome
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 69415 | TotalRevenueColumn |
| Exclusion | $69,415 | ExclusionAmount |
Gross Rents GrossRents
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 63920 | Real |
Less Rental Expenses LessRentalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 8150 | Real |
Rental Income Or Loss RentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 55770 | Real |
Net Rental Income Or Loss NetRentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 55770 | TotalRevenueColumn |
| Related Or Exempt Function Income | 22170 | RelatedOrExemptFunctionIncome |
| Exclusion | $33,600 | ExclusionAmount |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 25153395 | TotalRevenueColumn |
| Related Or Exempt Function Income | 24412288 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 0 | UnrelatedBusinessRevenue |
| Exclusion | $103,015 | ExclusionAmount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part IX | X | InfoInScheduleOPartIX |
Grants To Domestic Orgs GrantsToDomesticOrgs
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 2044 | Total |
| Program Services | 2044 | ProgramServices |
Comp Current Officers Directors CompCurrentOfficersDirectors
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 292324 | Total |
| Management And General | 292324 | ManagementAndGeneral |
Other Salaries And Wages OtherSalariesAndWages
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 8423439 | Total |
| Program Services | 7854861 | ProgramServices |
| Management And General | 506993 | ManagementAndGeneral |
| Fundraising | 61585 | Fundraising |
Pension Plan Contributions PensionPlanContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 287753 | Total |
| Program Services | 267676 | ProgramServices |
| Management And General | 17978 | ManagementAndGeneral |
| Fundraising | 2099 | Fundraising |
Other Employee Benefits OtherEmployeeBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 981949 | Total |
| Program Services | 901091 | ProgramServices |
| Management And General | 73793 | ManagementAndGeneral |
| Fundraising | 7065 | Fundraising |
Payroll Taxes PayrollTaxes
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 674450 | Total |
| Program Services | 609602 | ProgramServices |
| Management And General | 60068 | ManagementAndGeneral |
| Fundraising | 4780 | Fundraising |
Fees For Services Legal FeesForServicesLegal
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1818 | Total |
| Management And General | 1818 | ManagementAndGeneral |
Fees For Services Accounting FeesForServicesAccounting
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 62014 | Total |
| Management And General | 62014 | ManagementAndGeneral |
Fees For Services Other FeesForServicesOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 5821984 | Total |
| Program Services | 5716882 | ProgramServices |
| Management And General | 105102 | ManagementAndGeneral |
Advertising Advertising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 85219 | Total |
| Program Services | 85219 | ProgramServices |
Office Expenses OfficeExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 3677936 | Total |
| Program Services | 3615026 | ProgramServices |
| Management And General | 62910 | ManagementAndGeneral |
Occupancy Occupancy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 576390 | Total |
| Program Services | 576390 | ProgramServices |
Travel Travel
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 209730 | Total |
| Program Services | 157999 | ProgramServices |
| Management And General | 51731 | ManagementAndGeneral |
Conferences Meetings ConferencesMeetings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 6643 | Total |
| Program Services | 5597 | ProgramServices |
| Management And General | 1046 | ManagementAndGeneral |
Interest Interest
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 247893 | Total |
| Program Services | 247893 | ProgramServices |
Depreciation Depletion DepreciationDepletion
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1407133 | Total |
| Program Services | 1407133 | ProgramServices |
Insurance Insurance
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 72295 | Total |
| Program Services | 62699 | ProgramServices |
| Management And General | 9596 | ManagementAndGeneral |
Other Expenses OtherExpenses (4 entries)
| DescriptionDescription | TotalTotal | Program ServicesProgramServices | Management And GeneralManagementAndGeneral |
|---|---|---|---|
| Bad Debts | 788680 | 788680 | |
| Medical Supplies | 508477 | 508477 | |
| Recruitment | 203439 | 133163 | 70276 |
| Dues and Subscriptions | 56349 | 30098 | 26251 |
All Other Expenses AllOtherExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 60171 | Total |
| Program Services | 47596 | ProgramServices |
| Management And General | 8304 | ManagementAndGeneral |
| Fundraising | 4271 | Fundraising |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 24448130 | Total |
| Program Services | 23018126 | ProgramServices |
| Management And General | 1350204 | ManagementAndGeneral |
| Fundraising | 79800 | Fundraising |
Savings And Temp Cash Investments SavingsAndTempCashInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 4184607 | BOY |
| EOY | 3457254 | EOY |
Accounts Receivable AccountsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 4016673 | BOY |
| EOY | 4462194 | EOY |
Inventories For Sale Or Use InventoriesForSaleOrUse
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 542756 | BOY |
| EOY | 557143 | EOY |
Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 208162 | BOY |
| EOY | 230064 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Buildings Equipment Basis | 31430886 | LandBuildingsEquipmentBasis |
| Land Bldg Equipment Accum Deprec | 18071021 | LandBldgEquipmentAccumDeprec |
Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 13631696 | BOY |
| EOY | 13359865 | EOY |
Investments Pub Traded Securities InvestmentsPubTradedSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2331971 | BOY |
| EOY | 2422057 | EOY |
Other Assets Total OtherAssetsTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1931691 | BOY |
| EOY | 2442908 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 26847556 | BOY |
| EOY | 26931485 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1973368 | BOY |
| EOY | 1771123 | EOY |
Deferred Revenue DeferredRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 423733 | BOY |
Tax Exempt Bond Liabilities TaxExemptBondLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 5017666 | BOY |
| EOY | 4848841 | EOY |
Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 665225 | BOY |
| EOY | 1106008 | EOY |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 469847 | BOY |
| EOY | 174896 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 8549839 | BOY |
| EOY | 7900868 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Unrestricted Net Assets UnrestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 18297717 | BOY |
| EOY | 19030617 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 18297717 | BOY |
| EOY | 19030617 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 26847556 | BOY |
| EOY | 26931485 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | X | InfoInScheduleOPartXI |
| Reconcilation Revenue Expenses | 705265 | ReconcilationRevenueExpenses |
| Reconciliation Unrealized Invest | 26583 | ReconciliationUnrealizedInvest |
| Reconcilation Other Changes | 1052 | ReconcilationOtherChanges |
| Method Of Accounting Accrual | X | MethodOfAccountingAccrual |
| Accountant Compile Or Review | 0 | AccountantCompileOrReview |
| FS Audited | 1 | FSAudited |
FS Audited Basis FSAuditedBasis
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Statement Both | X | FinancialStatementBoth |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | 1 | AuditCommittee |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequired |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital170b1 Aiii | X | Hospital170b1Aiii |
Schedule B IRS990ScheduleB
Contributor Info ContributorInfo
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor Number | RESTRICTED | ContributorNumber |
Contributor Name Business ContributorNameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor Address US ContributorAddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Aggregate Contributions | RESTRICTED | AggregateContributions |
Schedule D IRS990ScheduleD
| Field | Value | IRS element (for citing) |
|---|---|---|
| Agent Trustee Etc | 1 | AgentTrusteeEtc |
| Beginning Balance | 9166 | BeginningBalance |
| Additions During Year | 10304 | AdditionsDuringYear |
| Distributions During Year | 11356 | DistributionsDuringYear |
| Ending Balance | 8114 | EndingBalance |
| Included On FS | 0 | IncludedOnFS |
Land Land
| Field | Value | IRS element (for citing) |
|---|---|---|
| Investment Cost Or Other Basis | 18000 | InvestmentCostOrOtherBasis |
| Other Cost Or Other Basis | 90113 | OtherCostOrOtherBasis |
| Book Value | 108113 | BookValue |
Buildings Buildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Investment Cost Or Other Basis | 1933866 | InvestmentCostOrOtherBasis |
| Other Cost Or Other Basis | 16973644 | OtherCostOrOtherBasis |
| Depreciation | 8539260 | Depreciation |
| Book Value | 10368250 | BookValue |
Equipment Equipment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Investment Cost Or Other Basis | 30107 | InvestmentCostOrOtherBasis |
| Other Cost Or Other Basis | 11711092 | OtherCostOrOtherBasis |
| Depreciation | 9180177 | Depreciation |
| Book Value | 2561022 | BookValue |
Other Land Buildings OtherLandBuildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 674064 | OtherCostOrOtherBasis |
| Depreciation | 351584 | Depreciation |
| Book Value | 322480 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Land Buildings | 13359865 | TotalOfBookValueLandBuildings |
Other Assets OtherAssets (3 entries)
| DescriptionDescription | Book ValueBookValue |
|---|---|
| Deferred financing costs | 89800 |
| Related party receivables | 1305239 |
| Estimated third-party payor settlements | 1047869 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Other Assets | 2442908 | TotalBookValueOtherAssets |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | Due to Related Party | Description |
| Amount | $174,896 | Amount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Amounts | 174896 | TotalOfAmounts |
| Footnote In Part XIII | X | FootnoteInPartXIII |
| Tot Revenue Etc Audited Fincl Stmt | 24389144 | TotRevenueEtcAuditedFinclStmt |
| Net Unrealized Gains Investments | 26583 | NetUnrealizedGainsInvestments |
| Other Revenues | -788680 | OtherRevenues |
| Revenue Not Rptd F990 | -762097 | RevenueNotRptdF990 |
| Revenue Subtotal | 25151241 | RevenueSubtotal |
| Other Revenues Not Included | 2154 | OtherRevenuesNotIncluded |
| Revenue Not Rptd On Fin Stmt | 2154 | RevenueNotRptdOnFinStmt |
| Total Revenue Per Form990 | 25153395 | TotalRevenuePerForm990 |
| Tot Expenses Etc Audited Fincl Stmt | 23656244 | TotExpensesEtcAuditedFinclStmt |
| Other Expenses Included | 8150 | OtherExpensesIncluded |
| Expenses Not Rptd F990 | 8150 | ExpensesNotRptdF990 |
| Expenses Subtotal | 23648094 | ExpensesSubtotal |
| Other Expenses Not Included | 800036 | OtherExpensesNotIncluded |
| Expenses Not Rptd On Fin Stmt | 800036 | ExpensesNotRptdOnFinStmt |
| Total Expenses Per Form990 | 24448130 | TotalExpensesPerForm990 |
Form990 Schedule D Part XIII Form990ScheduleDPartXIII (6 entries)
| Return ReferenceReturnReference | ExplanationExplanation | IdentifierIdentifier |
|---|---|---|
| Part IV, Line 1b: | The Hospital has an auxiliary that operates under their EIN. These funds are controlled by the auxiliary board members. | |
| Part X, Line 2: | West River Health Services (WRHS) is organized as a North Dakota nonprofit corporation and has been recognized by the Internal Revenue Service as exempt from federal income taxes under Internal Revenue Code Section 501(c)(3). WRHS is annually required to file a Return of Organization Exempt from Income Tax (Form 990) with the IRS. In addition, WRHS is subject to income tax on net income that is derived from business activities that are unrelated to its exempt purpose. WRHS has determined it is not subject to unrelated business income tax and has not filed an Exempt Organization Business Income Tax Return (Form 990T) with the IRS. WRHS believes that it has appropriate support for any tax positions taken affecting its annual filing requirements, and as such, does not have any uncertain tax positions that are material to the financial statements. WRHS would recognize future accrued interest and penalties related to unrecognized tax benefits and liabilities in income tax expense if such interest and penalties are incurred. | Description of Uncertain Tax Positions Under FIN 48: |
| Bad Debt Expense -788,680. | Part XI, Line 2d - Other Adjustments: | |
| Auxiliary revenue 10,304. Rental expenses included in revenue on Form 990 -8,150. | Part XI, Line 4b - Other Adjustments: | |
| Rental expenses included in revenue on Form 990 8,150. | Part XII, Line 2d - Other Adjustments: | |
| Auxiliary expenses 11,356. Bad Debt Expense 788,680. | Part XII, Line 4b - Other Adjustments: |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Charity Care Policy | 1 | CharityCarePolicy |
| Written Policy | 1 | WrittenPolicy |
| Policy Applied To All Hospitals | X | PolicyAppliedToAllHospitals |
| FPG Reference Free Care | 1 | FPGReferenceFreeCare |
| Pcent150 | X | Pcent150 |
| FPG Reference Discounted Care | 1 | FPGReferenceDiscountedCare |
| Pcent200 D | X | Pcent200D |
| Free Disc Care Medically Indigent | 1 | FreeDiscCareMedicallyIndigent |
| Amounts Budgeted For Charity Care | 1 | AmountsBudgetedForCharityCare |
| Expenses Exceeded Budget | 0 | ExpensesExceededBudget |
| Annual Community Benefit Report | 0 | AnnualCommunityBenefitReport |
Charity Care At Cost CharityCareAtCost
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 103000 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 103000 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00420 | PercentOfTotalExpense |
Unreimbursed Medicaid UnreimbursedMedicaid
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 1009588 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 622492 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 387096 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.01580 | PercentOfTotalExpense |
Total Charity Care TotalCharityCare
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 1112588 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 622492 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 490096 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.02000 | PercentOfTotalExpense |
Community Health Services CommunityHealthServices
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 39162 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 18891 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 20271 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00080 | PercentOfTotalExpense |
Subsidized Health Services SubsidizedHealthServices
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 1260987 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 896243 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 364744 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.01490 | PercentOfTotalExpense |
Cash And In Kind Contributions CashAndInKindContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 3070 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 3070 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00010 | PercentOfTotalExpense |
Total Other Benefits TotalOtherBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 1303219 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 915134 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 388085 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.01580 | PercentOfTotalExpense |
Total Community Benefits TotalCommunityBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 2415807 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 1537626 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 878181 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.03580 | PercentOfTotalExpense |
Coalition Building CoalitionBuilding
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Building Expense | 8610 | TotalCommunityBuildingExpense |
| Net Community Building Expense | 8610 | NetCommunityBuildingExpense |
| Percent Of Total Expense | 0.00040 | PercentOfTotalExpense |
Workforce Development WorkforceDevelopment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Building Expense | 70326 | TotalCommunityBuildingExpense |
| Net Community Building Expense | 70326 | NetCommunityBuildingExpense |
| Percent Of Total Expense | 0.00290 | PercentOfTotalExpense |
Total Total
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Building Expense | 78936 | TotalCommunityBuildingExpense |
| Net Community Building Expense | 78936 | NetCommunityBuildingExpense |
| Percent Of Total Expense | 0.00330 | PercentOfTotalExpense |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | 0 | BadDebtExpenseReported |
| Bad Debt Expense | $788,680 | BadDebtExpenseAmount |
| Amount Attributable To | 3707 | AmountAttributableTo |
| Amount Reimbursed By Medicare | 9477053 | AmountReimbursedByMedicare |
| Cost Of Care Reimbursed By Medicare | 9369240 | CostOfCareReimbursedByMedicare |
| Medicare Surplus Or Shortfall | 107813 | MedicareSurplusOrShortfall |
Costing Methodology Used CostingMethodologyUsed
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | X | Other |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | 1 | WrittenDebtCollectionPolicy |
| Provision For Charity Care | 1 | ProvisionForCharityCare |
| Number Of Hospital Facilities | 1 | NumberOfHospitalFacilities |
Form990 Schedule H Part V Section A Form990ScheduleHPartVSectionA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility Number | 1 | FacilityNumber |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | West River Health Services | BusinessNameLine1 |
Address Address
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1000 Highway 12 | AddressLine1 |
| City | Hettinger | City |
| State | ND | State |
| ZIP Code | 58639 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Licensed Hospital | X | LicensedHospital |
| General Medical And Surgical | X | GeneralMedicalAndSurgical |
| Critical Access Hospital | X | CriticalAccessHospital |
| Er24 Hours | X | Er24Hours |
| Other | Clinic & 5 RHC's - all provider based | Other |
Form990 Schedule H Part V Section B Form990ScheduleHPartVSectionB
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | West River Health Services | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital Facility Number | 1 | HospitalFacilityNumber |
| CHNA Conducted | 1 | CHNAConducted |
| Community Definition | X | CommunityDefinition |
| Community Demographics | X | CommunityDemographics |
| Existing Resources | X | ExistingResources |
| Community Health Needs | X | CommunityHealthNeeds |
| Other Health Issues | X | OtherHealthIssues |
| Identifying Process | X | IdentifyingProcess |
| Consulting Process | X | ConsultingProcess |
| Needs Assessment Conducted | 11 | NeedsAssessmentConducted |
| Take Into Account | 1 | TakeIntoAccount |
| Other Facilities | 0 | OtherFacilities |
| CHNA Widely Available | 1 | CHNAWidelyAvailable |
| Own Website | X | OwnWebsite |
| On Request | X | OnRequest |
| Adopt Implement Strategy | X | AdoptImplementStrategy |
| Execute Implement Strategy | X | ExecuteImplementStrategy |
| Adopt Budget | X | AdoptBudget |
| Prioritize Health Needs | X | PrioritizeHealthNeeds |
| Prioritize Services | X | PrioritizeServices |
| All Needs Addressed | 1 | AllNeedsAddressed |
| Organization Incur Excise Tax | 0 | OrganizationIncurExciseTax |
| Eligibility Criteria Explained | 1 | EligibilityCriteriaExplained |
| Uses FPG Free | 1 | UsesFPGFree |
| FPG Free Percent | 150.000000000000 | FPGFreePercent |
| Uses FPG Discounted | 1 | UsesFPGDiscounted |
| FPG Discount Percent | 200.000000000000 | FPGDiscountPercent |
| Explains Basis | 1 | ExplainsBasis |
| Income Level | X | IncomeLevel |
| Asset Level | X | AssetLevel |
| Medical Indigency | X | MedicalIndigency |
| Insurance Status | X | InsuranceStatus |
| Medicaid Medicare | X | MedicaidMedicare |
| State Regulation | X | StateRegulation |
| Explains Application Method | 1 | ExplainsApplicationMethod |
| Includes Publicity Measures | 1 | IncludesPublicityMeasures |
| Posted On Website | X | PostedOnWebsite |
| Available On Request | X | AvailableOnRequest |
| Other Publicity | X | OtherPublicity |
| Actions On Nonpayment | 1 | ActionsOnNonpayment |
| Collection Activities | 0 | CollectionActivities |
| Notify Upon Admission | X | NotifyUponAdmission |
| Notify Before Discharge | X | NotifyBeforeDischarge |
| Notified All Patients | X | NotifiedAllPatients |
| Documented Determination | X | DocumentedDetermination |
| Nondiscrim Emergency Care Policy | 1 | NondiscrimEmergencyCarePolicy |
| Used Other Method | X | UsedOtherMethod |
| Amounts Generally Billed | 1 | AmountsGenerallyBilled |
| Gross Charges | 1 | GrossCharges |
Form990 Schedule H Part V Section C Form990ScheduleHPartVSectionC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Other Facilities | 2 | NumberOfOtherFacilities |
Other Facilities OtherFacilities (2 entries)
| Address Line1Address/AddressLine1 | CityAddress/City | StateAddress/State | ZIP CodeAddress/ZIPCode | Facility TypeFacilityType |
|---|---|---|---|---|
| Hettinger West River Eye Center | ||||
| 1000 Hwy 12 | Hettinger | ND | 58639 | Clinic |
| West River Foot & Ankle Center | ||||
| 683 State Avenue Suite E | Dickinson | ND | 58601 | Clinic |
Form990 Schedule H Part VI Form990ScheduleHPartVI (16 entries)
| ExplanationExplanation | IdentifierIdentifier |
|---|---|
| Part I, Line 7: Charity care expense was converted to cost on line 7a based on an overall cost-to-charge ratio addressing all patient segments. Unreimbursed Medicaid on line 7b was calculated using the worksheet 3. The Organization used actual expenses to determine the cost for Community health improvement services on line 7e. The cost of subsidized health services reported on line 7g was determined using the Medicare Cost Report. | |
| Part I, L7 Col(f): The amount of bad debt included on Form 990, Part IX, line 24, column (A), but subtracted for purposes of calculating the percentage on this line is $788,680. | |
| Part II: Part II: Community Building ActivitiesLine 6 Coalition Building Several of the WRHS staff are members of the Adams County Disaster Management Team and, as such, are also represented on the Southwest Region Coalition for Disaster Management. These groups have been instrumental in developing disaster plans which encompass a variety of natural disasters in a team involving fire, police, rescue, and Hospital personnel. In this reporting period, $2,316 of community benefit expense was incurred. There was no direct offsetting revenue to the expense. Three employees from WRHS were represented on the Southwest Region Influenza Coalition. This Coalition works with the Southwest District Health Unit to help ensure adequate vaccination coverage for the underinsured and uninsured population of the area. The Coalition was also instrumental in assuring an adequate availability of both influenza and Tdap vaccine. The group met monthly to discuss current public health concerns and outbreaks. They provided much education to the public on benefits of influenza vaccinations and offered flu clinics at area farm shows and schools. In this reporting period, $1,350 of community benefit expense was incurred. There was no direct offsetting revenue to the expense. Numerous WRHS staff persons participate in the North Dakota Hospital Engagement Network. Representatives from members of hospitals around the State gather to discuss best practices and lessons learned during the care of their patients. The time committed to this program came at a cost of $4,944 during the current year. Grand total of all coalition building effort was $8,610.Line 8 - Workforce DevelopmentIncluded in the WRHS health care system is a 25-bed critical access hospital, eight clinics (located in Hettinger, Bowman, Scranton, New England, Dickinson, and Mott in North Dakota and Lemmon in South Dakota), a visiting nurse program, advanced life support ambulance service, plus a wide array of ancillary services to compliment the entirely of the system. The service area covers over 25,000 square miles and serves an estimated population of 25,000. One of the biggest challenges WRHS has and continues to face is finding a workforce willing to locate to this sparsely-populated area. Most communities within the system, including Hettinger, have been designated medical shortage areas. WRHS has long supported the need for health care services in even the remotest of areas. Recognizing that rural people deserve the same quality health care as do their urban counterparts, physicians and mid-levels travel daily to these remote sites in order to provide the health care these rural people so desperately need. Given the current shortage, recruitment has been a major expense over the past year. Expenses have included collaborative physician recruitment fees, expense to attend statewide recruitment fairs, forgiveness of academic loans for physicians, and expense to bring candidates on-site to see the West River system and to interview for positions. Recruitment expense for this reporting period totaled $70,326. Grant total of all workforce development activities was $70,326. | |
| Part III, Line 4: The footnote to the Organization's financial statements can be found on page 11 of the attached audited 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 that receive discounted care under the FAP the remaining self-pay portion falls under the same collection policy as all other patient accounts. The Hospital policy is to send the unpaid amounts to collections 45 days after this initial letter; however, the Hospital makes all efforts to work with the patients to collect on 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 V, Section A: West River Health Services operates Hettinger Clinic, a provider based clinic. The Hospital also operates five provider based rural health clinics: New England Clinic, Bowman Clinic, Scranton Clinic, Mott Clinic, and Lemmon Clinic. | |
| Part V, Section B, Line 3: Two versions of a survey tool were distributed to two different audiences:1. Community Members the community member survey was distributed to residents of the core services area of the Organization and was designed to gain an understanding of community awareness about services provided by WRHS and whether consumers are using those services, the community's need for services and concerns about the delivery of health care in the community, solicit suggestions and help identify any gaps in services, and determine preferences for using local healthcare versus traveling to other facilities. 2. Health Care Professionals the health care professional survey was distributed to 300 employees of WRHS. This survey covered the same topics as the consumer survey, although it sought less demographic information and excluded questions regarding the awareness of services offered by WRHS. One-on-one interviews with "key informants" identified by WRHS administrators were performed to gather information from citizens considered to be community leaders and were believed to represent the broad interests of the health community, business community, faith community, social services, nonprofit agencies, and public health.The information gathered through the processes outlined above along with demographic information from the 2010 census was used by the Organization in prioritizing and drafting an action plan to address identified needs. | West River Health Services |
| Part V, Section B, Line 14g: The Hospital provides a summary in plain language on the Hospital website, emergency and waiting rooms, admissions office, upon admission to the Hospital, and in packets provided in each patient room. The plain language summary includes information on where the patient can obtain access to the policy. | West River Health Services |
| Part V, Section B, Line 20d: The maximum amount charged to a patient under the financial assistance policy for emergency and medically necessary care is 80% of the gross charges. This is based on the lowest discount under the charity care policy of 20%. The hospital will review the proposed methods to determine amounts generally billed to determine its discount under the financial assistance policy meets the requirements of 501(r). | West River Health Services |
| Part V, Section B, Line 21: The hospital provides a reduction to gross charges. The hospital has not determined the amount generally billed under the various proposed methods of calculation. Therefore, it is possible a patient under the financial assistance policy could have paid more than the amount generally billed. The hospital will review the various methods to determine amounts generally billed to ensure it is in compliance with Section 501(r). | West River Health Services |
| Part V, Section B, Line 22: All individuals eligible under the hospital financial assistance policy are provided a discount for emergency and other medically necessary care. The financial assistance policy does not apply to elective procedures. Therefore, FAP-eligible patients without insurance may be charged gross charges on elective procedures. | West River Health Services |
| Part VI, Line 2: Board members from all affiliated Boards (WRHSF, WRHS, and WHLC) as well as WRHS medical staff met together at the annual Board retreat in January 2012 at which time results of the Community Health Needs Assessment conducted in July of 2011 were reviewed and discussed. The Needs Assessment served as the basis for health care strategic and long-range planning to develop healthy policy, allocate resources, improve or expand existing services, implement new programs, and collaborate with other community health care providers.There is wide representation from across the multi-county region on the WRHS Board of Directors. Board members routinely provide feedback to Administration and the Board of perceived health care needs based on discussions with patients in their respective communities. Although all members of the 14-member physician group with whom WRHS contracts for professional medical services reside in Hettinger, they travel daily/weekly to community clinics within the region. They have become advocates for each of these communities and represent the community needs to Administration and Board of Directors.WRHS conducts regular satisfaction surveys with patients who have received hospital/clinic services from WRHS. As part of those surveys, patients are asked for their input for improvement and/or to suggest other needed services. WRHS further identifies unmet community health needs by participating in community coalitions, partnerships, boards, committees, advisory groups, and panels locally and within the region.Based on the above-noted assessment measures, the major community needs identified for 2011 were the need to increase access to quality health care, especially for children, pregnant women, and uninsured adults and seniors; the need to obtain medical care for the underserved by enrolling eligible residents in Medicaid, SCHIP, and other insurance programs; the need to enhance and strengthen mental health services within the region by recruiting additional mental health providers; the need to consider the addition of orthopedic services; the need to recruit additional qualified physicians to this underserved area; and the need to provide health education, disease prevention and chronic disease management (including obesity) programs to improve the health status of the communities served. | |
| Part VI, Line 3: It is the mission of West River Health Services (WRHS) to provide comprehensive health and wellness services to all residents and visitors in the region it serves. These services are offered to all patients regardless of race, color, creed or ability to pay. We are committed to provide quality health care services with compassion and respect, particularly the underinsured and uninsured population. It is the policy of WRHS to provide effective communications with patients regarding Hospital bills, to make affirmative efforts to help patients apply for public and private financial support programs, to offer financial support to patients with limited means, to assist low-income patients in a consistent manner, and to maintain fair and consistent billing and collection practices for all patients with patient payment obligations. It is normally at the point of admission that the patient's ability to pay is assessed. Patients who are uninsured and believed to have limited resources are referred to the WRHS Financial Counselor who will determine patient's eligibility for charity care and/or other financial assistance programs. The Financial Counselor will also discuss with the patient the availability of various governmental programs, including Medicaid or other state-funded programs. Where appropriate, the Financial Counselor will assist the patient with qualification and/or application to such programs.Patients unable to pay their medical bills are invited to submit an application to the charity care program. Both the Financial Counselor and the Patient Financial Services Manager are readily available to visit with candidates to this program and to assist in the application process, as appropriate. WRHS informs patients of its financial assistance programs through the WRHS website, brochures available at points of admission and in the Patient Care Handbook located in each patient room. Every effort is made to determine a patient's eligibility prior to or at the time of admission or service. However, determination for financial support can be made during any stage of the patient's stay after stabilization or collection cycle.WRHS has established a written policy for the billing, collection and support for patients with payment obligations. WRHS makes every effort to adhere to the policy and is committed to applying the policy for assisting patients with limited means in a professional, consistent manner. WRHS educates staff members who work closely with patients (including those working in patient registration and admitting, financial assistance, customer service, billing, and collections) on the policies with an emphasis on treating all patients with dignity and respect regardless of their insurance status or their ability to pay for services. The Financial Counselor is given more in-depth training on handling financial assistance requests, processing of applications, and managing outcomes. | |
| Part VI, Line 4: Hettinger is located in southwestern North Dakota and borders the states of South Dakota and Montana. The City has a population of 1,226 with a total population of 2,343 in Adams County. In addition to the hospital and clinic services located in Hettinger, there are also rural clinics located in New England (Slope County), Bowman and Scranton (Bowman County), and Mott (Hettinger County), all in southwestern North Dakota. Another clinic is located in Lemmon, South Dakota (Perkins County). In total, West River Health Services provides health care to approximately 37,134 individuals over 25,000 square miles inclusive of the counties named. The median household income for these counties is $38,371, which is considerably below the North Dakota average of $46,781.Twenty-three percent of the population in all counties served is 65 years of age or older. Four hundred thirty-nine families within the service area fall below the federal poverty guidelines for an average of 11.7%. The North Dakota average for families falling below poverty levels is 12.3%. Not included to the above demographics is the City of Dickinson, 75 miles from Hettinger and located in Stark County. It is here that WRHS operates a weekly Foot and Ankle Center. With the exception of Dickinson, all other sites have been designated as medically underserved areas. Health care is an important part of the economy and, as such, the hospital and clinics have become one of the top employers in the region. Approximately 3.5% of all patients served are Medicaid recipients and 7.6% of all patients served are uninsured. There is another hospital and clinic in Bowman, located 40 miles west of Hettinger. There is also a hospital and several other clinics in Dickinson, located 75 northwest of Hettinger. Tertiary referral centers are located 150 miles away in Bismarck, North Dakota, and 180 miles away in Rapid City, South Dakota. | |
| Part VI, Line 5: West River Health Services is a not-for-profit organization whose mission is to provide comprehensive health and wellness services to residents and visitors of the region. We do this by reinvesting our profits back into the communities through various programs and services; making sure that care is available to everyone regardless of ability to pay; offering care with compassion to all patients; and providing a wide range of special benefits to each community, such as programs to manage care for persons with chronic diseases, health education and disease prevention initiatives, outreach for the elderly, and care for persons who are poor or uninsured.West River Health Services works with many community programs each year, often partnering with other organizations throughout the service area. The organization was instrumental in the application to and award of a Southwestern Area Healthcare Education Consortium, an outreach effort encompassing the western half of North Dakota. The goal of the SWAHEC is to assist health care providers in their recruitment and retention of health care workers throughout western North Dakota. Quite the contrast to other parts of the nation, North Dakota is facing severe shortage of workers in many industries, including health care. Members from the management team stay connected to the communities through their involvement with other community organizations, including membership on numerous community boards and committees. Doing so gives the Organization a voice and input into local activities, as well as serves as representation of health activities into each of the communities. The Board represents members from the community that are neither employees, nor contractors of the organization, nor family members thereof. WRHS extends medical staff privileges to all qualified physicians in its community for all of its departments. West River Health Services has a policy of using any of its surplus funds for improvements that promote a higher level of quality patient care.The Organization has long been a promoter of medical education and has enjoyed a longstanding relationship with the University of North Dakota School of Medicine in providing rotation sites for medical students. Physicians within the Organization graciously preceptor these students. With the support, endorsement, and approval of UND's Advisory Council, the State Board of Higher Education, and the UND School of Medicine and Health Sciences, the North Dakota State Legislature approved the initial funding for an expansion of Graduate Medical Education residencies with the State. West River Regional Medical Center of Hettinger was included to the funding proposal and will partner with the Bismarck Center for Family Medicine to offer residencies to Year Two and Three students in a rural setting. This is a collaborative effort between all entities to ensure an adequate supply of professionals for the future, especially primary care providers and particularly to rural areas. This partnership will be invaluable as it will help to address the number one concern identified through the Health Needs Assessment, that of a critical shortage of healthcare providers. In addition to total uncompensated care for FY '13 of $157,778, WRHS also provides many other services as in-kind support to benefit the health of the communities and region it serves. These community benefits include offering CPR and first aid programs to the general public, guiding tours of the hospital/clinic to area school children, providing health and wellness education classes to the public, and educating/training paramedics/EMTs in all outreach communities.Hettinger has a locally-owned radio station. This station has a program called TTO (This, That, and Other Things). This program airs daily (M-F). WRHS has a designated hour per month to share information about healthy happenings and to promote general health and well-being. During this reporting period, the following topics were discussed on TTO: influenza precautions and infection control, medication/prescription cards, general wellness and fitness, diabetic education, WIC, assistance provided by WRHS to the uninsured and/or underinsured, public access to electronic health information, etc. WRHS costs shown were for staff time to prepare and participate in the talk show. Two of the WRHS OB staff annually teach fourth, fifth and sixth graders at the public school about puberty and its changes for both boys and girls. Hygiene, hormonal changes, and body development phases are a major part of this curriculum. Physicians, mid-levels, and nurses were finding it difficult to keep current records on the medications and dosages patients were taking. In response to this issue, several nurses and the Hospital pharmacist met and subsequently designed medication cards to be mass distributed to all patients within the service area. The wallet-size medication card offers an excellent tool for patients to manage his/her own medications as well as to inform providers of the meds the patient is currently taking. Several hours have been devoted by staff to help in the education of the card use as well as how to fill them out appropriately. The tool has been heartily received by the public. West River Health Services and the clinics it operates are located in a very sparsely-populated rural area. Transportation for seniors to/from clinic appointments is difficult and expensive. Many seniors often opt to not come for their appointment in light of the cost and inconvenience of getting to the clinic. Recognizing the importance of these patients to keep their appointments and maintain optimal health, WRHS is sharing in the cost for seniors to travel to/from the clinics. Locally-established senior vans are used for this service and WRHS reimburses one-half the cost of the transportation in getting patients to/from clinic and/or hospital services. For more information about WRHS, visit www.wrhs.com. |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Compensation Committee | X | CompensationCommittee |
| Compensation Survey | X | CompensationSurvey |
| Board Or Committee Approval | X | BoardOrCommitteeApproval |
| Severance Payment | 0 | SeverancePayment |
| Supplemental Nonqual Retire Plan | 0 | SupplementalNonqualRetirePlan |
| Equity Based Comp Arrangement | 0 | EquityBasedCompArrangement |
| Comp Based On Revenue Of Filing Org | 0 | CompBasedOnRevenueOfFilingOrg |
| Comp Based On Revenue Related Orgs | 0 | CompBasedOnRevenueRelatedOrgs |
| Comp Based Net Earnings Filing Org | 0 | CompBasedNetEarningsFilingOrg |
| Comp Based Net Earnings Relate Orgs | 0 | CompBasedNetEarningsRelateOrgs |
| Any Non Fixed Payments | 0 | AnyNonFixedPayments |
| Initial Contract Exception | 0 | InitialContractException |
Form990 Schedule J Part II Form990ScheduleJPartII (2 entries)
| TitleTitle | Base Compensation Filing OrgBaseCompensationFilingOrg | Comp Based On Related OrgsCompBasedOnRelatedOrgs | Bonus Filing OrgBonusFilingOrg | Bonus Related OrgsBonusRelatedOrgs | Other Compensation Filing OrgOtherCompensationFilingOrg | Other Compensation Related OrgsOtherCompensationRelatedOrgs | Deferred Comp Filing OrgDeferredCompFilingOrg | Deferred Comp Related OrgsDeferredCompRelatedOrgs | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrg | Nontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgs | Total Compensation Filing OrgTotalCompensationFilingOrg | Total Compensation Related OrgsTotalCompensationRelatedOrgs | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrg | Comp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Jim Long | ||||||||||||||
| CEO | 152558 | 0 | 0 | 0 | 0 | 0 | 10654 | 0 | 10088 | 0 | 173300 | 0 | 0 | 0 |
| Susan Hallen | ||||||||||||||
| Pharmacist | 152779 | 0 | 0 | 0 | 0 | 0 | 4607 | 0 | 8034 | 0 | 165420 | 0 | 0 | 0 |
Schedule K IRS990ScheduleK
Form990 Schedule K Part I Form990ScheduleKPartI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
Issuer Name IssuerName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | City of Hettinger North Dakota | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Issuer EIN | 456002094 | IssuerEIN |
| Date Issued | 2008-01-31 | DateIssued |
| Issue Price | 5275000 | IssuePrice |
| Description Of Purpose | Expand & renovate hospital/Hettinger | DescriptionOfPurpose |
| Defeased | 0 | Defeased |
| On Behalf Of Issuer | 0 | OnBehalfOfIssuer |
| Pool Financing | 0 | PoolFinancing |
Form990 Schedule K Part II Form990ScheduleKPartII
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Total Proceeds | 5275000 | TotalProceeds |
| Issuance Costs From Proceeds | 105500 | IssuanceCostsFromProceeds |
| Capital Expenditures | 5169500 | CapitalExpenditures |
| Year Of Subst Completion | 2010 | YearOfSubstCompletion |
| Current Refunding | 0 | CurrentRefunding |
| Advance Refunding | 0 | AdvanceRefunding |
| Final Allocation Made | 1 | FinalAllocationMade |
| Adequate Books And Recds Maintaind | 1 | AdequateBooksAndRecdsMaintaind |
Form990 Schedule K Part III Form990ScheduleKPartIII
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Owning Bond Financed Property | 0 | OwningBondFinancedProperty |
| Any Lease Arrangements | 0 | AnyLeaseArrangements |
| Mngment Cntrct Bond Financd Prprty | 0 | MngmentCntrctBondFinancdPrprty |
| Any Research Agreements | 0 | AnyResearchAgreements |
| Prcntge Prvt Business Use By Others | 0.00000 | PrcntgePrvtBusinessUseByOthers |
| Percentage Of Prvt Business Re UBI | 0.00000 | PercentageOfPrvtBusinessReUBI |
| Total Private Business Use | 0.00000 | TotalPrivateBusinessUse |
| Bond Iss Meet Prvt Security Pay Test | 0 | BondIssMeetPrvtSecurityPayTest |
| Change In Use Bond Financed Prop | 0 | ChangeInUseBondFinancedProp |
| Non Qualified Bond Remed Procdrs | 0 | NonQualifiedBondRemedProcdrs |
Form990 Schedule K Part IV Form990ScheduleKPartIV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Form8038 T Filed | 0 | Form8038TFiled |
| Rebate Not Due Yet | 0 | RebateNotDueYet |
| Exception To Rebate | 0 | ExceptionToRebate |
| No Rebate Due | 0 | NoRebateDue |
| Variable Rate Issue | 1 | VariableRateIssue |
| Hedge Identified In Books And Recds | 0 | HedgeIdentifiedInBooksAndRecds |
| Gross Proceeds Invested In GIC | 0 | GrossProceedsInvestedInGIC |
| Gross Proceeds Invested | 0 | GrossProceedsInvested |
| Written Proc To Monitor Reqs | 0 | WrittenProcToMonitorReqs |
Form990 Schedule K Part V Form990ScheduleKPartV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Proc To Undertk Corrective Action | 0 | ProcToUndertkCorrectiveAction |
Form990 Schedule K Part VI Form990ScheduleKPartVI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | Schedule K, Part IV, Line 2 | Identifier |
| Return Reference | Rebate Computation | ReturnReference |
| Explanation | West River Health Services has determined that a rebate computation was not warranted due to the tax-exempt bond being a draw down bond that did not have invested proceeds. | Explanation |
Schedule L IRS990ScheduleL
Form990 Schedule L Part IV Form990ScheduleLPartIV (3 entries)
| RelationshipRelationship | Amount Of TransactionAmountOfTransaction | Description Of TransactionDescriptionOfTransaction | Sharing Of RevenuesSharingOfRevenues |
|---|---|---|---|
| Jenifer Long | |||
| Spouse of Jim Long, CEO | 39081 | Compensation | 0 |
| Ria Eaton | |||
| Spouseof Jonathan Eaton, Director | 39197 | Compensation | 0 |
| Dana Andress | |||
| Spouse of Eric Andress, Director | 54592 | Compensation | 0 |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (10 entries)
| Return ReferenceReturnReference | ExplanationExplanation | IdentifierIdentifier |
|---|---|---|
| Form 990, Part VI, Section A, line 1 | There is an Executive Committee that has the 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 the 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 11 | 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 in the board minutes. | |
| Form 990, Part VI, Section B, line 15a | CEO: Each board and medical staff member annually complete 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 was last reviewed in April of 2012. | |
| 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 1,646,914. Management and general expenses 0. Fundraising expenses 0. Total expenses 1,646,914. Physician Services: Program service expenses 3,589,951. Management and general expenses 0. Fundraising expenses 0. Total expenses 3,589,951. Other Fees: Program service expenses 480,017. Management and general expenses 105,102. Fundraising expenses 0. Total expenses 585,119. | Other Fees |
| Form 990, Part XI, line 9: | Auxiliary net income change 1,052. | Changes in Net Assets or Fund Balances: |
Schedule R IRS990ScheduleR
Form990 Schedule R Part II Form990ScheduleRPartII (2 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EINEIN | Primary ActivitiesPrimaryActivities | Legal Domicile StateLegalDomicileState | Exempt Code SectionExemptCodeSection | Public Charity StatusPublicCharityStatus | Business Name Line1DirectControllingEntityName/BusinessNameLine1 | Controlled OrgControlledOrg | Direct Controlling Entity NADirectControllingEntityNA |
|---|---|---|---|---|---|---|---|---|---|---|---|
| Western Horizons Living Centers | |||||||||||
| 1104 Highway 12 | Hettinger | ND | 58369 | 260794602 | Long-term care/assisted living services | ND | 501(c)(3) | Line 9 | West River Health Services Foundation | 0 | |
| West River Health Services Foundation | |||||||||||
| 1000 Highway 12 | Hettinger | ND | 58639 | 450411825 | Fundraising | ND | 501(c)(3) | Line 11c, III-FI | 0 | N/A | |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Ann Rents Royalties | 0 | ReceiptOfIntAnnRentsRoyalties |
| Gift Grant Or Cap Contr To Other Org | 0 | GiftGrantOrCapContrToOtherOrg |
| Gift Grant Or Cap Contr Fr Other Org | 1 | GiftGrantOrCapContrFrOtherOrg |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrg |
| Loans Or Guarantees From Other Org | 0 | LoansOrGuaranteesFromOtherOrg |
| Dividends Related Organization | 0 | DividendsRelatedOrganization |
| Sale Of Assets To Other Org | 0 | SaleOfAssetsToOtherOrg |
| Purchase Of Assets From Other Org | 0 | PurchaseOfAssetsFromOtherOrg |
| Exchange Of Assets | 0 | ExchangeOfAssets |
| Rental Of Facilities To Other Orgs | 1 | RentalOfFacilitiesToOtherOrgs |
| Rental Of Facilities Fr Other Orgs | 0 | RentalOfFacilitiesFrOtherOrgs |
| Perform Of Services For Other Orgs | 0 | PerformOfServicesForOtherOrgs |
| Perform Of Services By Other Orgs | 0 | PerformOfServicesByOtherOrgs |
| Sharing Of Facilities | 1 | SharingOfFacilities |
| Sharing Of Paid Employees | 1 | SharingOfPaidEmployees |
| Reimbursement Paid To Other Org | 0 | ReimbursementPaidToOtherOrg |
| Reimbursement Paid By Other Org | 1 | ReimbursementPaidByOtherOrg |
| Other Transfer To Other Org | 0 | OtherTransferToOtherOrg |
| Other Transfer From Other Org | 0 | OtherTransferFromOtherOrg |