2013-02-04T09:05:21-06:00 2012-03-31 450250958 EIDE BAILLY LLP 4310 17TH AVE S PO BOX 2545 FARGO ND 581082545 990 2011-04-01 450340688 WEST RIVER HEALTH SERVICES WEST 7015674561 1000 HIGHWAY 12 HETTINGER ND 58639 JIM K LONG 7015674561 2013-01-22 1 LISA CHAFFEE CPA P00193453 7012398500 2013-01-22 2011 2016-02-25 16:41:14Z WEST RIVER REGIONAL MEDICAL CENTER JIM K LONG 1000 HIGHWAY 12 HETTINGER ND 58639 25679596 0 X WWW.WRHS.COM X 1950 ND PROVIDE COMPREHENSIVE HEALTH AND WELLNESS SERVICES TO THE RESIDENTS AND VISITORS OF THE REGION. 11 8 300 5 0 0 74595 1680639 23540930 23873368 73310 61464 55602 53775 23744437 25669246 500 6137 0 0 10440440 10288219 0 0 91245 13100359 13575766 23541299 23870122 203138 1799124 24059990 26847556 7567952 8549839 16492038 18297717 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 22463111 6137 23797778 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 2012, WRHS PROVIDED ACUTE CARE SERVICES TO 1,021 PATIENTS FOR A TOTAL OF 4,052 DAYS OF CARE. SWING BED SERVICES WERE PROVIDED TO 95 PATIENTS FOR A TOTAL OF 741 DAYS OF CARE. IN ADDITION, 530 DAYS OF OBSERVATION CARE WERE PROVIDED. THERE WERE 1,703 EMERGENCY ROOM VISITS DURING THE YEAR. EIGHTY-SEVEN BABIES WERE BORN DURING THE YEAR WITH A TOTAL OF 209 DAYS OF CARE PROVIDED. THERE WERE A TOTAL OF 952 SURGICAL CASES DURING THE YEAR, WITH 772 OF THOSE BEING DONE ON AN OUTPATIENT BASIS. THE AMBULANCE CREW MADE 237 AMBULANCE RUNS/TRANSFERS THROUGHOUT THE YEAR. THERE WERE 41,500 CLINIC ENCOUNTERS TO THE SEVEN CLINICS. ANCILLARY SERVICES WERE PROVIDED AS FOLLOWS: 198,589 LAB TESTS; 10,998 RADIOLOGY TESTS; 9,316 RESPIRATORY THERAPY TESTS; 38,593 MEALS TO PATIENTS, VISITORS, AND EMPLOYEES; AND 12,843 THERAPY VISITS. THROUGHOUT THE YEAR, THERE WERE 2,002 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 '12 FOR ELIGIBLE INDIVIDUALS WAS $326,535. THIS AMOUNT REFLECTS THE AMOUNT OF CHARGES FOREGONE BASED ON ESTABLISHED RATES. 22463111 1 1 0 0 0 0 0 0 1 0 1 0 0 1 1 1 1 1 0 0 0 0 0 0 0 0 1 1 1 0 1 1 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 1 0 0 0 0 1 33 0 1 300 1 0 0 0 0 0 0 0 0 0 0 X 11 8 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 0 0 X KARAN EHLERS AND NATHAN STADHEIM 7015676150 1000 HIGHWAY 12 HETTINGER ND 58639 X CODY JORGENSON 2.00 X X 240 0 0 ERIC ANDRESS 2.00 X X 190 0 0 HALEY EVANS 2.00 X X 80 0 0 GARY DEWHIRST 2.00 X 170 0 0 DALE WEGH 2.00 X 100 0 0 CLEVE TESKE 2.00 X 130 0 0 ROBERT PARKER 2.00 X 160 0 0 LARRY JACKSON 2.00 X 190 0 0 DR STEVEN KILWIEN 2.00 X 0 0 0 TRAVIS ELLISON 2.00 X 170 0 0 JONATHAN EATON 2.00 X 20 0 0 JIM LONG 36.00 X 148440 0 19567 KARAN EHLERS 29.00 X 75674 0 24526 SUSAN HALLEN 40.00 X 143496 0 12426 MITCH SCHULTZ 40.00 X 104877 0 19352 473937 0 75871 3 0 1 0 UNITED CLINICS PHYSICIAN PC 1100 HIGHWAY 12 HETTINGER ND 58639 PHYSICIAN SERVICES 4082483 DR MARK KRISTY 1000 HIGHWAY 12 HETTINGER ND 58639 RADIOLOGY SERVICES 325466 MONDAK IMAGING SERVICES 11 SOUTH 7TH ST SUITE 241 MILES CITY MT 59301 MRI SERVICES 234519 WEATHERBY LOCUMS INC PO BOX 972633 DALLAS TX 753972633 LOCUMS PHYSICIAN SERVICES 206897 AVERA HEALTH 3900 WEST AVERA DR SUITE 301 SIOUX FALLS SD 57108 E-EMERGENCY SERVICES 142667 7 2000 1407059 58515 213065 1680639 PATIENT SERVICE REVENU 621110 23055653 23055653 OTHER 900099 328976 328976 AFFILIATION SUPPORT 900099 300000 300000 CAFETERIA 722210 97114 97114 ASSISTED LIVING RENT 621610 91625 91625 23873368 61464 61464 61175 8276 52899 52899 21524 31375 2950 2000 2074 876 876 25669246 23797778 0 190829 6137 6137 267904 267904 155251 155251 7887135 7345307 471098 70730 288325 269246 16541 2538 1101208 1010659 81019 9530 588396 532741 50631 5024 11691 11691 63232 63232 5957231 5854447 102784 84822 84822 3554168 3492506 61662 616906 616906 210440 163776 46664 1844 500 1344 256497 256497 1239203 1239203 69824 62058 7766 BAD DEBTS 674464 674464 MEDICAL SUPPLIES 502928 502928 RECRUITMENT 207194 125490 81704 DUES AND SUBSCRIPTIONS 57542 31535 26007 67780 38638 25719 3423 23870122 22463111 1315766 91245 1621226 4184607 3848974 4016673 571913 542756 199464 208162 30291963 16660267 13915779 13631696 1879491 2331971 2023143 1931691 24059990 26847556 1945005 1973368 423733 5230699 5017666 665225 392248 469847 7567952 8549839 X 16492038 18297717 16492038 18297717 24059990 26847556 X 1799124 6555 X 0 1 1 X 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 1 6620 13288 10742 9166 0 18000 90113 108113 1885210 16961710 7885151 10961769 30107 10711771 8445675 2296203 595052 329441 265611 13631696 DEFERRED FINANCING COSTS 94328 RELATED PARTY RECEIVABLES 1837363 1931691 DUE TO RELATED PARTY 469847 469847 25669246 23870122 1799124 9101 -2546 6555 1805679 25603763 9101 -71646 -62545 25666308 2938 2938 25669246 23798084 10350 10350 23787734 82388 82388 23870122 PART IV, LINE 1B: THE HOSPITAL HAS AN AUXILIARY THAT OPERATES UNDER THEIR EIN. THESE FUNDS ARE CONTROLLED BY THE AUXILIARY BOARD MEMBERS. DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X: 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. PART XI, LINE 8 - OTHER ADJUSTMENTS: AUXILIARY NET INCOME CHANGE -2,546. PART XII, LINE 2D - OTHER ADJUSTMENTS: RENTAL PROPERTY DEPRECIATION INCLUDED IN REVENUE ON FINANCIAL STATEMENTS -71,646. PART XII, LINE 4B - OTHER ADJUSTMENTS: AUXILIARY REVENUE 13,288. RENTAL EXPENSES INCLUDED IN REVENUE ON FORM 990 -8,276. FUNDRAISING EXPENSES INCLUDED IN REVENUE ON FORM 990 -2,074. PART XIII, LINE 2D - OTHER ADJUSTMENTS: RENTAL EXPENSES INCLUDED IN REVENUE ON FORM 990 8,276. FUNDRAISING EXPENSES INCLUDED IN REVENUE ON FORM 990 2,074. PART XIII, LINE 4B - OTHER ADJUSTMENTS: AUXILIARY EXPENSES 10,742. RENTAL PROPERTY DEPRECIATION INCLUDED IN REVENUE ON FINANCIAL STATEMENTS 71,646. 1 1 X 1 X 1 X 195.000000000000 1 1 1 0 0 216000 216000 0.00930 361628 285426 76202 0.00330 577628 285426 292202 0.01260 63638 19607 44031 0.00190 9446320 7227560 2218760 0.09570 9509958 7247167 2262791 0.09760 10087586 7532593 2554993 0.11020 10202 10202 0.00040 38849 38849 0.00170 49051 49051 0.00210 0 674464 6542 7016522 6947051 69471 X 1 1 1 1 WEST RIVER HEALTH SERVICES

1000 HIGHWAY 12 HETTINGER ND 58639

X X X X CLINIC & 5 RHC'S - ALL PROVIDER BASED WEST RIVER HEALTH SERVICES 1 1 1 150.000000000000 1 195.000000000000 1 X X X X X X 1 1 X X 1 0 1 X 1 1 2 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 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 COSTING METHODS TO PREPARE THE COST REPORTS. 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 $674,464. PART II: PART II - COMMUNITY BUILDING ACTIVITIESLINE 6 - COALITION BUILDINGSEVERAL 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, THE MANAGEMENT TEAM PLANNED TWO COUNTY-WIDE DISASTER EXERCISES TO BETTER PREPARE ALL PERSONNEL FOR A NATURAL OR MANMADE DISASTER. IN ADDITION TO REPRESENTATION ON THIS MANAGEMENT TEAM, ONE WRHS MEMBER OF THE TEAM ALSO WAS TRAINED TO ASSIST THE LOCAL RAILROAD CREW IN EVENT OF A SPILL ON THE RAIL LINE RUNNING THROUGH ADAMS AND/OR SURROUNDING COUNTIES. IN THIS REPORTING PERIOD, $9,362 OF COMMUNITY BENEFIT EXPENSE WAS INCURRED. THERE WAS NO DIRECT OFFSETTING REVENUE TO THE EXPENSE. ALSO DURING THIS REPORTING PERIOD, TWO EMPLOYEES FROM WRHS (QUALITY ASSURANCE/QUALITY IMPROVEMENT STAFF) 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 FREQUENTLY 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, $840 OF COMMUNITY BENEFIT EXPENSE WAS INCURRED. THERE WAS NO DIRECT OFFSETTING REVENUE TO THE EXPENSE. GRAND TOTAL OF ALL COALITION BUILDING EFFORT WAS $10,202.PART II, 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 A 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. THIS REPORTING YEAR HAS BEEN ESPECIALLY DIFFICULT SINCE SEVERAL PHYSICIANS HAVE EITHER RETIRED OR RELOCATED LEAVING THE SYSTEM WITH A CRITICAL PHYSICIAN SHORTAGE. 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, PHYSICIAN/MID-LEVEL 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 LOAN REPAYMENT FOR PHYSICIANS, AND EXPENSE TO BRING POTENTIAL PHYSICIAN/MID-LEVEL CANDIDATES ON-SITE TO SEE THE WEST RIVER SYSTEM AND TO INTERVIEW FOR POSITIONS. RECRUITMENT EXPENSE RELATED TO THESE ENDEAVORS FOR THIS REPORTING PERIOD TOTALED $37,314. UNLIKE MANY PARTS OF THE STATE OR ACROSS THE NATION, HETTINGER AND ITS COMMUNITY CLINIC SITES FACE A BURDENSOME MANPOWER SHORTAGE FOR MANY HEALTH CARE PROFESSIONALS AS WELL AS ANCILLARY SERVICE WORKERS BECAUSE WE MUST COMPETE WITH OIL FIELD DEVELOPMENT AND AN INDUSTRY THAT IS PAYING MUCH HIGHER WAGES, WE OFTEN COMPETE FOR THE SAME LABOR FORCE. WRHS IS AN ADVOCATE FOR EDUCATION AND EFFORTS TO "GROW" A CLIENTELE THAT WILL HOPEFULLY RETURN TO THE AREA FOR PERMANENT JOBS AT SOME TIME IN THE FUTURE. IN THIS PAST YEAR, WRHS ONCE AGAIN PARTICIPATED IN A SCRUBS CAMP FOR AREA SCHOOLS. THIS WAS A ONE DAY EVENT WHICH OFFERED STUDENTS A PERSPECTIVE ON HEALTH CAREERS AND ASSISTANCE AVAILABLE TO THEM IF THEY CHOOSE TO ADVANCE THEIR EDUCATION IN A MEDICAL FIELD. THIS WAS A VERY SUCCESSFUL EVENT AND WELL OVER 250 STUDENTS WERE IN ATTENDANCE. SEVEN STAFF FROM WRHS ATTENDED THE CAMP AND MANNED BOOTHS TO ANSWER QUESTIONS AND GIVE SPECIFIC INFORMATION ON CAREERS IN THE HEALTH CARE FIELD. DIRECT COSTS FOR STAFF TO PARTICIPATE WERE $1,228; INDIRECT COSTS WERE $307. TOTAL WAS $1,535. THERE WAS NO OFFSETTING REVENUE TO THIS PROJECT. GRANT TOTAL OF ALL WORKFORCE DEVELOPMENT ACTIVITIES WAS $38,849. PART III, LINE 4: 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 POLICY IS APPROXIMATELY $6,542. THIS WAS BASED ON AN ESTIMATE OF CHARGES FOREGONE TO GROSS PATIENT CHARGES.FOOTNOTE TO ORGANIZATION'S FINANCIAL STATEMENTS THAT DESCRIBES BAD DEBT EXPENSE:THE CARRYING AMOUNT OF PATIENT RECEIVABLES IS REDUCED BY A VALUATION ALLOWANCE THAT REFLECTS MANAGEMENT'S ESTIMATE OF AMOUNTS THAT WILL NOT BE COLLECTED FROM PATIENTS AND THIRD-PARTY PAYORS. MANAGEMENT REVIEWS PATIENT RECEIVABLES BY PAYOR CLASS AND APPLIES PERCENTAGES TO DETERMINE ESTIMATED AMOUNTS THAT WILL NOT BE COLLECTED FROM THIRD PARTIES UNDER CONTRACTUAL AGREEMENTS AND AMOUNTS THAT WILL NOT BE COLLECTED FROM PATIENTS DUE TO BAD DEBTS. MANAGEMENT CONSIDERS HISTORICAL WRITE OFF AND RECOVERY INFORMATION IN DETERMINING THE ESTIMATED BAD DEBT PROVISION. 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: 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 '12 FOR ELIGIBLE INDIVIDUALS WAS $326,535. THIS AMOUNT REFLECTS THE AMOUNT OF CHARGES FOREGONE BASED ON ESTABLISHED RATES. THE ESTIMATED COST OF PROVIDING THESE SERVICES WAS $216,000.IF DURING THE CHECK-IN REGISTRATION PROCESS FOR NONEMERGENCY CARE ONLY, THE PATIENT IS UNABLE TO PAY THE DESIGNATED CO-PAY AMOUNT THEIR FILE IS IMMEDIATELY REFERRED TO THE SELF-PAY COLLECTIONS REPRESENTATIVE OR PATIENT ACCOUNT MANAGER TO ASSIST WITH THE APPLICATION TO APPLY FOR THE FREE OR DISCOUNTED CARE UNDER THE CHARITY CARE POLICY.IF THE PATIENT IS DETERMINED TO BE ELIGIBLE FOR FINANCIAL ASSISTANCE THE HOSPITAL REQUESTS THAT THEY PAY, ON AVERAGE, 50% OF THE PAYMENT THAT WILL BE DUE. THE HOSPITAL DOES ITS BEST TO WORK WITH PATIENTS THAT CANNOT AFFORD MEDICAL CARE. THE PATIENT ACCOUNT MANAGER WILL SEND THE BILL OUT AFTER THE SERVICES ARE PERFORMED, SIMILAR TO THE THE BILLING PROCESS THAT IS USED FOR OTHER PATIENTS WHO DO NOT QUALIFY FOR FINANCIAL ASSISTANCE. 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. IN REGARDS TO NON ELECTIVE AND EMERGENCY CARE, ONCE AN INDIVIDUAL IS ELIGIBLE FOR CHARITY CARE, THEY ARE ELIGIBLE FOR UP TO SIX MONTHS OF CHARITY CARE UNDER THE HOSPITAL'S POLICIES. AFTER THE SIX MONTHS IS OVER, THEY MAY RE-SUBMIT AN APPLICATION FOR CHARITY CARE TO EXTEND THIS FOR ANOTHER SIX MONTHS. 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 LEMON CLINIC. WEST RIVER HEALTH SERVICES PART V, SECTION B, LINE 13G: THE HOSPITAL ALSO 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. WEST RIVER HEALTH SERVICES PART V, SECTION B, LINE 19D: THE HOSPITAL CURRENTLY STARTS WITH GROSS CHARGES FOR ALL PATIENT BILLINGS. FOR INSURED PATIENTS THE CONTRACTED INSURANCE RATE IS APPLIED TO GROSS CHARGES, AND THEN WE APPLY THE FINANCIAL ASSISTANCE PERCENTAGE. IN REGARDS TO SELF-PAY PATIENTS, THE FINANCIAL ASSISTANCE PERCENTAGE IS APPLIED DIRECTLY TO THE GROSS CHARGES. AT THE TIME OF THE FILINGS THE HOSPITAL WAS NOT USING ONE OF THE TWO APPROVED METHODS FOR DETERMINING THE AMOUNTS GENERALLY BILLED BEFORE APPLYING THE FINANCIAL ASSISTANCE PERCENTAGE. THE HOSPITAL IS CURRENTLY REVIEWING AND DEVELOPING A POLICY THAT WOULD BE IN COMPLIANCE WITH THE REGULATIONS. WEST RIVER HEALTH SERVICES PART V, SECTION B, LINE 20: THE HOSPITAL CURRENTLY CHARGES ALL PATIENTS GROSS CHARGES AND APPLIES THE FINANCIAL ASSISTANCE PERCENTAGE DIRECTLY TO GROSS CHARGES FOR THOSE THAT DO NOT HAVE INSURANCE. WEST RIVER HEALTH SERVICES PART V, SECTION B, LINE 21: THE HOSPITAL CURRENTLY CHARGES ALL PATIENTS GROSS CHARGES AND APPLIES THE FINANCIALS ASSISTANCE PERCENTAGES DIRECTLY TO CHARGES FOR THOSE THAT DO NOT HAVE INSURANCE. 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.SEVERAL YEARS AGO, WRHS IMPLEMENTED THE GOOD NEIGHBOR PROGRAM. THIS IS A PROGRAM DESIGNED TO PROVIDE FINANCIAL ASSISTANCE TO UNDERINSURED ELIGIBLE PATIENTS THROUGHOUT THE REGION. FUNDING FOR THE PROGRAM WAS THROUGH A PUBLIC FUNDRAISING CAMPAIGN. THOSE FUNDS, ALONG WITH AN ANNUAL SUSTAINABILITY CONTRIBUTION BY WRHS, HAVE ALLOWED THIS PROGRAM TO CONTINUE YET TODAY. IT IS PROMOTED VIA BROCHURES, NEWSPAPER, AND THE WRHS WEBSITE.IN ADDITION TO THIS PROGRAM, 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. THE FIRST RESIDENTS ARE SCHEDULED TO BE IN PLACE BY JULY OF 2013. IN ADDITION TO TOTAL UNCOMPENSATED CARE FOR FY '12 OF $326,535, 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, EDUCATING/TRAINING PARAMEDICS/EMTS IN ALL OUTREACH COMMUNITIES, ELECTRONICALLY SENDING THE REPORTER (TO INFORM ON HEALTH-RELATED ISSUES AND TO UPDATE ON EDUCATIONAL MEETINGS) BI-MONTHLY TO 12,000 HOUSEHOLDS.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. COMMUNITY BENEFIT EXPENSE IN THIS REPORTING PERIOD WAS $3,691.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. WRHS COSTS WERE FOR STAFF TIME TO PREPARE AND TEACH THE CLASSES AT THE SCHOOL (TOTAL OF $631). IN ADDITION, THERE WERE COSTS OF $200 FOR HANDOUTS AND SUPPLIES GIVEN TO STUDENTS. TOTAL COSTS WERE $831.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 SERIVE 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. STAFF COSTS INVOLVED TO THIS PROJECT WERE $2,432. IN ADDITION, THERE WAS A COST OF $300 TO PRINT THE MEDICATION CARDS. TOTAL COSTS WERE $2,732.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. COSTS FOR THIS SERVICE DURING THIS REPORTING PERIOD WERE $6,688.FOR MORE INFORMATION ABOUT WRHS, VISIT WWW.WRHS.COM. 1 WEST RIVER HEALTH SERVICES FOUNDATION 1000 HIGHWAY 12 HETTINGER ND 58639 450411825 501(C)(3) 6137 DONATION TO FOUNDATION TO DISTRIBUTE FOR HEALTH SERVICES 1 0 PROCEDURE FOR MONITORING GRANTS IN THE U.S.: PART I, LINE 2: SCHEDULE I, PART I, LINE 2: WEST RIVER HEALTH SERVICES FOUNDATION IS A SUPPORTING ORGANIZATION OF WEST RIVER HEALTH SERVICES. THE GRANT GIVEN TO THE FOUNDATION REPRESENTS THE NET PROFIT FROM A FUNDRAISING EVENT. WEST RIVER HEALTH SERVICES RECEIVED THE DONATIONS AND PARTICIPANT FEES, PAID THE EXPENSES, AND THE NET PROCEEDS WERE GIVEN TO THE FOUNDATION. THE FOUNDATION DISTRIBUTED THE FUNDS EQUALLY TO THE WELLNESS CENTER AT THE HOSPITAL, PARTNERS IN HEALTH FOR THE FOUNDATION, NURSING HOME AND AMBULANCE/EMS AT THE HOSPITAL. X X X 0 0 0 0 0 0 0 0 0 JIM LONG 148440 0 0 0 0 0 10528 0 10431 0 169399 0 0 0 SUSAN HALLEN 143496 0 0 0 0 0 4351 0 9211 0 157058 0 0 0 CITY OF HETTINGER NORTH DAKOTA 456002094 2008-01-31 5275000 EXPAND & RENOVATE HOSPITAL/HETTINGER 0 0 0 5275000 105500 5169500 2010 0 0 1 1 0 0 0 0 0.00000 0.00000 0.00000 1 0 1 0 0 0 0 JENIFER LONG SPOUSE OF JIM LONG, CEO 36838 COMPENSATION 0 KATHY EHLERS DAUGHTER-IN-LAW OF KARAN EHLERS, CFO 15253 COMPENSATION 0 PENNY WEGH SPOUSE OF DALE WEGH, DIRECTOR 15041 COMPENSATION 0 RIA EATON SPOUSEOF JONATHAN EATON, DIRECTOR 36394 COMPENSATION 0 DANA ANDRESS SPOUSE OF ERIC ANDRESS, DIRECTOR 51725 COMPENSATION 0 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 2011. 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 VII: IN ADDITION TO THE HOURS SERVED AT WEST RIVER HEALTH SERVICES, KARAN EHLERS SERVES AN ADDITIONAL 9 HOURS AT WESTERN HORIZONS LIVING CENTER (WHLC) AND 2 HOURS AT THE WEST RIVER HEALTH SERVICES FOUNDATION (WRHSF); JIM LONG SERVES AN ADDITIONAL 2 HOURS AT WHLC AND 2 HOURS AT WRHSF; LARRY JACKSON SERVES AN ADDITIONAL 2 HOURS AT WHLC. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: NET UNREALIZED GAINS ON INVESTMENTS: 9,101. AUXILIARY NET INCOME CHANGE -2,546. TOTAL TO FORM 990, PART XI, LINE 5: 6,555. WESTERN HORIZONS LIVING CENTERS 1104 HIGHWAY 12 HETTINGER ND 58369 260794602 LONG-TERM CARE/ASSISTED LIVING SERVICES ND 501(C)(3) 9 WEST RIVER HEALTH SERVICES FOUNDATION 0 WEST RIVER HEALTH SERVICES FOUNDATION 1000 HIGHWAY 12 HETTINGER ND 58639 450411825 FUNDRAISING ND 501(C)(3) 11A N/A 0 0 1 1 0 0 0 0 0 1 0 0 0 1 1 0 1 0 0