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WEST RIVER HEALTH SERVICES: Form 990, tax year 2009

View the entire original 990 at ProPublica ↗

Organization
WEST RIVER HEALTH SERVICES (EIN 45-0340688)
Tax period
2009-04-01 to 2010-03-31
Filed
2011-02-09
IRS object ID
201110409349300406
Schema version
2009v1.7
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 ReturnHeader

FieldValueIRS element (for citing)
Timestamp2011-02-09T09:00:03-06:00Timestamp
Tax Period End Date2010-03-31TaxPeriodEndDate

Preparer Firm PreparerFirm

Preparer Firm Business Name PreparerFirmBusinessName

FieldValueIRS element (for citing)
Business Name Line1EIDE BAILLY LLPBusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

FieldValueIRS element (for citing)
Address Line14310 17TH AVE S PO BOX 2545AddressLine1
CityFARGOCity
StateNDState
ZIP Code581082545ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnType
Tax Period Begin Date2009-04-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN450340688EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1West River Health ServicesBusinessNameLine1
FieldValueIRS element (for citing)
Name ControlWESTNameControl
Phone7015674561Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line11000 Highway 12AddressLine1
CityHettingerCity
StateNDState
ZIP Code58639ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NameJim K LongName
TitleCEOTitle
Phone7015674561Phone
Date Signed2011-02-08DateSigned
Authorize Third Party1AuthorizeThirdParty

Preparer Preparer

FieldValueIRS element (for citing)
NameLISA CHAFFEE CPAName
Phone7012398500Phone
Date Prepared2011-02-08DatePrepared
FieldValueIRS element (for citing)
Tax Year2009TaxYear
Build TS2016-02-24 21:20:13ZBuildTS

Form 990 IRS990

Doing Business As DoingBusinessAs

FieldValueIRS element (for citing)
Business Name Line1West River Regional Medical CenterBusinessNameLine1
FieldValueIRS element (for citing)
Name Of Principal Officer PersonJim K LongNameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line11000 Highway 12AddressLine1
CityHettingerCity
StateNDState
ZIP Code58639ZIPCode
FieldValueIRS element (for citing)
Gross Receipts23446580GrossReceipts
Group Return For Affiliates0GroupReturnForAffiliates
Organization501cXOrganization501c
Web Sitewww.wrhs.comWebSite
Type Of Organization CorporationXTypeOfOrganizationCorporation
Year Formation1950YearFormation
State Legal DomicileNDStateLegalDomicile
Activity Or Mission DescriptionProvide comprehensive health and wellness services to the residents and visitors of the region.ActivityOrMissionDescription
Nbr Voting Members Governing Body10NbrVotingMembersGoverningBody
Nbr Independent Voting Members10NbrIndependentVotingMembers
Total Nbr Employees319TotalNbrEmployees
Total Nbr Volunteers5TotalNbrVolunteers
Total Gross UBI0TotalGrossUBI
Net Unrelated Business Txbl Income0NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year516158ContributionsGrantsPriorYear
Contributions Grants Current Year153711ContributionsGrantsCurrentYear
Program Service Revenue Prior Year21432862ProgramServiceRevenuePriorYear
Program Service Revenue CY23117323ProgramServiceRevenueCY
Investment Income Prior Year114214InvestmentIncomePriorYear
Investment Income Current Year110627InvestmentIncomeCurrentYear
Other Revenue Prior Year56061OtherRevenuePriorYear
Other Revenue Current Year57239OtherRevenueCurrentYear
Total Revenue Prior Year22119295TotalRevenuePriorYear
Total Revenue Current Year23438900TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year3412GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY4100GrantsAndSimilarAmntsCY
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Prior Year9461508SalariesEtcPriorYear
Salaries Etc Current Year10103759SalariesEtcCurrentYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year96297TotalFundrsngExpCurrentYear
Other Expense Prior Year12151578OtherExpensePriorYear
Other Expenses Current Year13162422OtherExpensesCurrentYear
Total Expenses Prior Year21616498TotalExpensesPriorYear
Total Expenses Current Year23270281TotalExpensesCurrentYear
Revenues Less Expenses Prior Year502797RevenuesLessExpensesPriorYear
Revenues Less Expenses CY168619RevenuesLessExpensesCY
Total Assets BOY22951503TotalAssetsBOY
Total Assets EOY23965813TotalAssetsEOY
Total Liabilities BOY6980306TotalLiabilitiesBOY
Total Liabilities EOY7686536TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY15971197NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY16279277NetAssetsOrFundBalancesEOY
Mission DescriptionThe 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 Services0SignificantNewProgramServices
Significant Change0SignificantChange
Expense21928970Expense
Grants4100Grants
Revenue23140212Revenue
DescriptionWest 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 2010, WRHS provided acute care services to 982 patients for a total of 3,703 days of care. Swing bed services were provided to 149 patients for a total of 1,077 days of care. In addition, 691 days of observation care were provided. There were 1,733 emergency room visits during the year. Ninety-eight babies were born during the year with a total of 239 days of care provided. There were a total of 999 surgical cases during the year, with 802 of those being done on an outpatient basis. The ambulance crew made 290 ambulance runs/transfers throughout the year. There were 44,838 clinic encounters to the seven clinics. Ancillary services were provided as follows: 205,080 lab tests; 12,776 radiology tests; 8,284 respiratory therapy tests; 41,559 meals to patients, visitors, and employees; and 12,013 therapy visits. Throughout the year, there were 1,802 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 2007, 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 '10 for eligible individuals was $183,120. These amounts reflect the amount of charges foregone based on established rates.In addition to total uncompensated care for FY '10 of $942,447, 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 conducting health screenings at all area farm and home shows, offering CPR and first aid programs to the general public, organizing/conducting an annual Fun Run & Walk during the 4th of July celebration, providing free educational pamphlets and brochures on various health topics to the general public, guiding tours of the hospital/clinic to area school children, providing health and wellness education classes to the public, assisting seniors/elderly to enroll and take part in medication assistance programs, educating/training paramedics/EMTs in all outreach communities, maintaining a health resource library for the general public, sending The Reporter (to inform on health-related issues and to update on educational meetings) quarterly to 12,000 households, and maintaining a fitness center for the public.Description
Total Program Service Expense21928970TotalProgramServiceExpense
Described In501 C31DescribedIn501C3
Schedule B Required1ScheduleBRequired
Political Activities0PoliticalActivities
Lobbying Activities0LobbyingActivities
Donor Advised Funds0DonorAdvisedFunds
Conservation Easements0ConservationEasements
Collections Of Art0CollectionsOfArt
Credit Counseling0CreditCounseling
Term Or Permanent Endowments0TermOrPermanentEndowments
Balance Sheet Amounts Reported1BalanceSheetAmountsReported
Independent Audit Financial Stmt0IndependentAuditFinancialStmt
Consolidated Audit Financial Stmt1ConsolidatedAuditFinancialStmt
School0School
Foreign Office0ForeignOffice
Foreign Activities0ForeignActivities
More Than5000 K To Organizations0MoreThan5000KToOrganizations
More Than5000 K To Individuals0MoreThan5000KToIndividuals
Professional Fundraising0ProfessionalFundraising
Fundraising Activities0FundraisingActivities
Gaming0Gaming
Hospital1Hospital
Grants To Organizations0GrantsToOrganizations
Grants To Individuals0GrantsToIndividuals
Schedule J Required1ScheduleJRequired
Tax Exempt Bonds1TaxExemptBonds
Invest Tax Exempt Bonds0InvestTaxExemptBonds
Escrow Account0EscrowAccount
On Behalf Of Issuer0OnBehalfOfIssuer
Excess Benefit Transaction0ExcessBenefitTransaction
Prior Excess Benefit Transaction0PriorExcessBenefitTransaction
Loan To Officer Or DQP0LoanToOfficerOrDQP
Grant To Related Person0GrantToRelatedPerson
Bsnss Rltnshp With Organization0BsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family Member0BsnssRltnshpThruFamilyMember
Officer Entity With Bsnss Rltnshp0OfficerEntityWithBsnssRltnshp
Deductible Non Cash Contributions0DeductibleNonCashContributions
Deductible Contributions Of Art0DeductibleContributionsOfArt
Terminated0Terminated
Partial Liquidation0PartialLiquidation
Disregarded Entity0DisregardedEntity
Related Entity1RelatedEntity
Related Org Controlled Entity0RelatedOrgControlledEntity
Transfers To Exempt Non Chrtbl Org0TransfersToExemptNonChrtblOrg
Activities Conducted Partnership0ActivitiesConductedPartnership
Schedule O Required1ScheduleORequired
Number Forms Transmitted With109641NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Compliance With Backup Witholding1ComplianceWithBackupWitholding
Number Of Employees319NumberOfEmployees
Employment Tax Returns Filed1EmploymentTaxReturnsFiled
Unrelated Business Income0UnrelatedBusinessIncome
Foreign Financial Account0ForeignFinancialAccount
Prohibited Tax Shelter Trans0ProhibitedTaxShelterTrans
Taxable Party Notification0TaxablePartyNotification
Non Deductible Contributions0NonDeductibleContributions
Quid Pro Quo Contributions0QuidProQuoContributions
Form8282 Property Disposed Of0Form8282PropertyDisposedOf
Funds To Pay Premiums0FundsToPayPremiums
Premiums Paid0PremiumsPaid
Nbr Voting Governing Body Members10NbrVotingGoverningBodyMembers
Number Independent Voting Members10NumberIndependentVotingMembers
Family Or Business Relationship0FamilyOrBusinessRelationship
Delegation Of Management Duties0DelegationOfManagementDuties
Changes To Organizing Docs0ChangesToOrganizingDocs
Material Diversion Or Misuse0MaterialDiversionOrMisuse
Members Or Stockholders1MembersOrStockholders
Election Of Board Members1ElectionOfBoardMembers
Decisions Subject To Approval1DecisionsSubjectToApproval
Minutes Of Governing Body1MinutesOfGoverningBody
Minutes Of Committees1MinutesOfCommittees
Officer Mailing Address0OfficerMailingAddress
Local Chapters0LocalChapters
Form990 Provided To Governing Body1Form990ProvidedToGoverningBody
Conflict Of Interest Policy1ConflictOfInterestPolicy
Annual Disclosure Covered Persons1AnnualDisclosureCoveredPersons
Regular Monitoring Enforcement1RegularMonitoringEnforcement
Whistleblower Policy1WhistleblowerPolicy
Document Retention Policy1DocumentRetentionPolicy
Compensation Process CEO1CompensationProcessCEO
Compensation Process Other1CompensationProcessOther
Investment In Joint Venture0InvestmentInJointVenture
Upon RequestXUponRequest

The Books Are In Care Of TheBooksAreInCareOf

Name Business NameBusiness

FieldValueIRS element (for citing)
Business Name Line1Karan EhlersBusinessNameLine1
FieldValueIRS element (for citing)
Telephone Number7015676150TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line11000 Highway 12AddressLine1
CityHettingerCity
StateNDState
ZIP Code58639ZIPCode

Form990 Part VII Section A Form990PartVIISectionA (18 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekIndividual Trustee Or DirectorIndividualTrusteeOrDirectorReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensationOfficerOfficerHighest Compensated EmployeeHighestCompensatedEmployee
Travis Ellison
Chair2.00X22000
Cody Jorgenson
Vice Chair2.00X26000
Lance Ketterling
Secretary/Treasurer2.00X26000
Eric Andress
Board Director2.00X6000
Gary Dewhirst
Board Director2.00X25000
Larry Jackson
Board Director2.00X6000
Doug Jerde
Board Director2.00X14000
Robert Parker
Board Director2.00X21000
Cleve Teske
Board Director2.00X2000
Dale Wegh
Board Director2.00X5000
Dr John Joyce
Board Director2.00X000
Mike Clayton
Past Chair2.00X14000X
Arloween Remington
Past Vice Chair2.00X18000X
Linda Weaver Braaten
Past Secr/Treas2.00X17000X
Karan Ehlers
CFO28.0074733021891X
Jim Long
CEO34.00143114016487X
Susan Hallen
Pharmacist40.00138944011031X
Mitch Schultz
Pharmacist40.00102740015041X
FieldValueIRS element (for citing)
Total Reportable Comp From Org461551TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs0TotalReportableCompFrmRltdOrgs
Total Other Compensation64450TotalOtherCompensation
Number Individuals GT100 K3NumberIndividualsGT100K
Formers Listed0FormersListed
Total Comp GT150 K1TotalCompGT150K
Compensation From Other Sources1CompensationFromOtherSources

Contractor Compensation ContractorCompensation (5 entries)

Address Line1AddressOfContractor/AddressUS/AddressLine1CityAddressOfContractor/AddressUS/CityStateAddressOfContractor/AddressUS/StateZIP CodeAddressOfContractor/AddressUS/ZIPCodeDescription Of ServicesDescriptionOfServicesCompensationCompensation
United Clinics Physician PC
1100 Highway 12HettingerND58639Physician Services4091518
Dr Mark Kristy
1000 Highway 12HettingerND58639Radiology Services408456
Capital City Construction
PO Box 7337BismarckND58507Construction257668
Mondak Imaging Services
11 South 7th St Suite 241Miles CityMT59301MRI Services244639
Robert Gibb & Sons Inc
PO Box 10188FargoND58106Mechanical Contractor147535
FieldValueIRS element (for citing)
Number Of Contractors GT100 K7NumberOfContractorsGT100K
Fundraising Events2336FundraisingEvents
Government Grants24220GovernmentGrants
All Other Contributions127155AllOtherContributions
Total Contributions153711TotalContributions

Program Service Revenue ProgramServiceRevenue (5 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnRelated Or Exempt Function IncomeRelatedOrExemptFunctionIncome
Patient Service Revenu6211102230500922305009
Affiliation Support900099300000300000
Assisted Living Rent900099106860106860
Cafeteria7222108176981769
Insurance Proceeds9000995945959459

Total Oth Program Service Revenue TotalOthProgramServiceRevenue

FieldValueIRS element (for citing)
Total Revenue Column264226TotalRevenueColumn
Related Or Exempt Function Income264226RelatedOrExemptFunctionIncome
FieldValueIRS element (for citing)
Total Program Service Revenue23117323TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column110627TotalRevenueColumn
Exclusion$110,627ExclusionAmount

Gross Rents GrossRents

FieldValueIRS element (for citing)
Real60050Real

Less Rental Expenses LessRentalExpenses

FieldValueIRS element (for citing)
Real6911Real

Rental Income Or Loss RentalIncomeOrLoss

FieldValueIRS element (for citing)
Real53139Real

Net Rental Income Or Loss NetRentalIncomeOrLoss

FieldValueIRS element (for citing)
Total Revenue Column53139TotalRevenueColumn
Related Or Exempt Function Income22889RelatedOrExemptFunctionIncome
Exclusion$30,250ExclusionAmount
FieldValueIRS element (for citing)
Gross Income Fundraising Events4869GrossIncomeFundraisingEvents
Cntrbtns Rprtd Fundraising Events2336CntrbtnsRprtdFundraisingEvents
Fundraising Direct Expenses769FundraisingDirectExpenses

Net Income From Fundraising Events NetIncomeFromFundraisingEvents

FieldValueIRS element (for citing)
Total Revenue Column4100TotalRevenueColumn
Exclusion$4,100ExclusionAmount

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column23438900TotalRevenueColumn
Related Or Exempt Function Income23140212RelatedOrExemptFunctionIncome
Unrelated Business Revenue0UnrelatedBusinessRevenue
Exclusion$144,977ExclusionAmount

Grants To Domestic Individuals GrantsToDomesticIndividuals

FieldValueIRS element (for citing)
Total4100Total
Program Services4100ProgramServices

Comp Current Officers Directors CompCurrentOfficersDirectors

FieldValueIRS element (for citing)
Total261905Total
Management And General261905ManagementAndGeneral

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total7688969Total
Program Services7188563ProgramServices
Management And General428842ManagementAndGeneral
Fundraising71564Fundraising

Pension Plan Contributions PensionPlanContributions

FieldValueIRS element (for citing)
Total272227Total
Program Services254761ProgramServices
Management And General14930ManagementAndGeneral
Fundraising2536Fundraising

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total1312355Total
Program Services1203605ProgramServices
Management And General96768ManagementAndGeneral
Fundraising11982Fundraising

Payroll Taxes PayrollTaxes

FieldValueIRS element (for citing)
Total568303Total
Program Services515469ProgramServices
Management And General47702ManagementAndGeneral
Fundraising5132Fundraising

Fees For Services Legal FeesForServicesLegal

FieldValueIRS element (for citing)
Total3861Total
Management And General3861ManagementAndGeneral

Fees For Services Accounting FeesForServicesAccounting

FieldValueIRS element (for citing)
Total48367Total
Management And General48367ManagementAndGeneral

Fees For Services Other FeesForServicesOther

FieldValueIRS element (for citing)
Total5937209Total
Program Services5845391ProgramServices
Management And General91818ManagementAndGeneral

Advertising Advertising

FieldValueIRS element (for citing)
Total93070Total
Program Services93070ProgramServices

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total3679958Total
Program Services3593934ProgramServices
Management And General86024ManagementAndGeneral

Occupancy Occupancy

FieldValueIRS element (for citing)
Total527408Total
Program Services526007ProgramServices
Management And General1401ManagementAndGeneral

Travel Travel

FieldValueIRS element (for citing)
Total187579Total
Program Services143385ProgramServices
Management And General44194ManagementAndGeneral

Conferences Meetings ConferencesMeetings

FieldValueIRS element (for citing)
Total3861Total
Program Services2687ProgramServices
Management And General1174ManagementAndGeneral

Interest Interest

FieldValueIRS element (for citing)
Total235955Total
Program Services235955ProgramServices

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total1148171Total
Program Services1148171ProgramServices

Insurance Insurance

FieldValueIRS element (for citing)
Total65354Total
Program Services57680ProgramServices
Management And General7674ManagementAndGeneral

Other Expenses OtherExpenses (5 entries)

DescriptionDescriptionTotalTotalProgram ServicesProgramServicesManagement And GeneralManagementAndGeneral
Bad Debts905468905468
Recruitment16864612869939947
Dues and Subscriptions640344120022834
Employee Activities Exp2303623036
Lost Charge Expense60796079

All Other Expenses AllOtherExpenses

FieldValueIRS element (for citing)
Total64366Total
Program Services34746ProgramServices
Management And General24537ManagementAndGeneral
Fundraising5083Fundraising

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total23270281Total
Program Services21928970ProgramServices
Management And General1245014ManagementAndGeneral
Fundraising96297Fundraising

Savings And Temp Cash Investments SavingsAndTempCashInvestments

FieldValueIRS element (for citing)
BOY1779789BOY
EOY2632000EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY4147196BOY
EOY3596592EOY

Inventories For Sale Or Use InventoriesForSaleOrUse

FieldValueIRS element (for citing)
BOY493727BOY
EOY500007EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY155820BOY
EOY208794EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis28140058LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec14514857LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY13601046BOY
EOY13625201EOY

Investments Pub Traded Securities InvestmentsPubTradedSecurities

FieldValueIRS element (for citing)
BOY1602142BOY
EOY1916000EOY

Other Assets Total OtherAssetsTotal

FieldValueIRS element (for citing)
BOY1171783BOY
EOY1487219EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY22951503BOY
EOY23965813EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY1943505BOY
EOY1947573EOY

Grants Payable GrantsPayable

FieldValueIRS element (for citing)
BOY1000BOY

Tax Exempt Bond Liabilities TaxExemptBondLiabilities

FieldValueIRS element (for citing)
BOY4485272BOY
EOY5254170EOY

Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp

FieldValueIRS element (for citing)
BOY250123BOY
EOY179405EOY

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
BOY300406BOY
EOY305388EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY6980306BOY
EOY7686536EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY15971197BOY
EOY16279277EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY15971197BOY
EOY16279277EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY22951503BOY
EOY23965813EOY
FieldValueIRS element (for citing)
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or Review0AccountantCompileOrReview
FS Audited1FSAudited
Audit Committee1AuditCommittee
Financial Statement ConsolidatedXFinancialStatementConsolidated
Federal Grant Audit Required0FederalGrantAuditRequired

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Hospital170b1 AiiiXHospital170b1Aiii

Schedule B IRS990ScheduleB

Contributor Info ContributorInfo

FieldValueIRS element (for citing)
Contributor NumberRESTRICTEDContributorNumber

Contributor Name Business ContributorNameBusiness

FieldValueIRS element (for citing)
Business Name Line1RESTRICTEDBusinessNameLine1

Contributor Address US ContributorAddressUS

FieldValueIRS element (for citing)
Address Line1RESTRICTEDAddressLine1
Address Line2RESTRICTEDAddressLine2
CityRESTRICTEDCity
StateRESTRICTEDState
ZIP CodeRESTRICTEDZIPCode
FieldValueIRS element (for citing)
Aggregate ContributionsRESTRICTEDAggregateContributions

Schedule D IRS990ScheduleD

FieldValueIRS element (for citing)
Agent Trustee Etc1AgentTrusteeEtc
Beginning Balance5579BeginningBalance
Additions During Year17636AdditionsDuringYear
Distributions During Year15707DistributionsDuringYear
Ending Balance7508EndingBalance

Land Land

FieldValueIRS element (for citing)
Investment Cost Or Other Basis18000InvestmentCostOrOtherBasis
Other Cost Or Other Basis90113OtherCostOrOtherBasis
Book Value108113BookValue

Buildings Buildings

FieldValueIRS element (for citing)
Investment Cost Or Other Basis1713121InvestmentCostOrOtherBasis
Other Cost Or Other Basis15164505OtherCostOrOtherBasis
Depreciation6631349Depreciation
Book Value10246277BookValue

Equipment Equipment

FieldValueIRS element (for citing)
Investment Cost Or Other Basis30107InvestmentCostOrOtherBasis
Other Cost Or Other Basis9440465OtherCostOrOtherBasis
Depreciation7599198Depreciation
Book Value1871374BookValue

Other Land Buildings OtherLandBuildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis1683747OtherCostOrOtherBasis
Depreciation284310Depreciation
Book Value1399437BookValue
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings13625201TotalOfBookValueLandBuildings

Other Assets OtherAssets (2 entries)

DescriptionDescriptionBook ValueBookValue
Deferred financing costs103384
Related Party Receivables1383835
FieldValueIRS element (for citing)
Total Book Value Other Assets1487219TotalBookValueOtherAssets

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
DescriptionDue to Related PartyDescription
Amount$305,388Amount
FieldValueIRS element (for citing)
Total Of Amounts305388TotalOfAmounts
Total Revenue23438900TotalRevenue
Total Expenses23270281TotalExpenses
Excess Or Deficit For Year168619ExcessOrDeficitForYear
Net Unrealized GL On Investments147302NetUnrealizedGLOnInvestments
Other-$7,841OtherAmount
Total Adjustments139461TotalAdjustments
Excess Or Deficit Per FS308080ExcessOrDeficitPerFS
Tot Revenue Etc Audited Fincl Stmt23509551TotRevenueEtcAuditedFinclStmt
Net Unrealized Gains Investments147302NetUnrealizedGainsInvestments
Other Revenues-66695OtherRevenues
Revenue Not Rptd F99080607RevenueNotRptdF990
Revenue Subtotal23428944RevenueSubtotal
Other Revenues Not Included9956OtherRevenuesNotIncluded
Revenue Not Rptd On Fin Stmt9956RevenueNotRptdOnFinStmt
Total Revenue Per Form99023438900TotalRevenuePerForm990
Tot Expenses Etc Audited Fincl Stmt23195559TotExpensesEtcAuditedFinclStmt
Other Expenses Included7680OtherExpensesIncluded
Expenses Not Rptd F9907680ExpensesNotRptdF990
Expenses Subtotal23187879ExpensesSubtotal
Other Expenses Not Included82402OtherExpensesNotIncluded
Expenses Not Rptd On Fin Stmt82402ExpensesNotRptdOnFinStmt
Total Expenses Per Form99023270281TotalExpensesPerForm990

Form990 Schedule D Part XIV Form990ScheduleDPartXIV (7 entries)

IdentifierIdentifierExplanationExplanationReturn ReferenceReturnReference
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:The Foundation, WRHS, and WHLC are organized as North Dakota nonprofit corporations and have been recognized by the Internal Revenue Service as exempt from federal income taxes under Internal Revenue Code Section 501(c)(3). The Company undergoes an annual analysis of its various tax positions; assessing the likelihood of these positions being upheld upon examination with relevant tax authorities, as defined by the accounting principles generally accepted in the United States of America. The Company believes that it is compliant with all IRS tax regulations and as of March 31, 2010 has not recorded a tax liability for a tax uncertainty.Description of Uncertain Tax Positions Under FIN 48:
Part XI, Line 8 - Other Adjustments:Auxiliary net income change: -7841.
Part XII, Line 2d - Other Adjustments:Rental Property Depreciation Included in Revenue on Financial Statements: -66695.
Part XII, Line 4b - Other Adjustments:Special Events Expense: -769. Auxiliary revenue: 17636. Rental expenses: -6911.
Part XIII, Line 2d - Other Adjustments:Special Events Expense: 769. Rental Property Expenses : 6911.
Part XIII, Line 4b - Other Adjustments:Auxiliary expenses: 15707. Rental Property Depreciation Included in Revenue on Financial Statements: 66695.

Schedule H IRS990ScheduleH

FieldValueIRS element (for citing)
Charity Care Policy1CharityCarePolicy
Written Policy1WrittenPolicy
Policy Applied To All HospitalsXPolicyAppliedToAllHospitals
FPG Reference Free Care1FPGReferenceFreeCare
Pcent150XPcent150
FPG Reference Discounted Care1FPGReferenceDiscountedCare
Pcent250XPcent250
Free Disc Care Medically Indigent1FreeDiscCareMedicallyIndigent
Amounts Budgeted For Charity Care1AmountsBudgetedForCharityCare
Expenses Exceeded Budget1ExpensesExceededBudget
Unable To Provide Care0UnableToProvideCare
Annual Community Benefit Report0AnnualCommunityBenefitReport

Charity Care At Cost CharityCareAtCost

FieldValueIRS element (for citing)
Total Community Benefit Expense112891TotalCommunityBenefitExpense
Net Community Benefit Expense112891NetCommunityBenefitExpense
Percent Of Total Expense0.00510PercentOfTotalExpense

Unreimbursed Medicaid UnreimbursedMedicaid

FieldValueIRS element (for citing)
Total Community Benefit Expense685399TotalCommunityBenefitExpense
Direct Offsetting Revenue573929DirectOffsettingRevenue
Net Community Benefit Expense111470NetCommunityBenefitExpense
Percent Of Total Expense0.00500PercentOfTotalExpense

Unreimbursed Costs UnreimbursedCosts

FieldValueIRS element (for citing)
Total Community Benefit Expense20197TotalCommunityBenefitExpense
Direct Offsetting Revenue32762DirectOffsettingRevenue
Net Community Benefit Expense-12565NetCommunityBenefitExpense
Percent Of Total Expense0.00000PercentOfTotalExpense

Total Charity Care TotalCharityCare

FieldValueIRS element (for citing)
Total Community Benefit Expense818487TotalCommunityBenefitExpense
Direct Offsetting Revenue606691DirectOffsettingRevenue
Net Community Benefit Expense211796NetCommunityBenefitExpense
Percent Of Total Expense0.01010PercentOfTotalExpense

Community Health Services CommunityHealthServices

FieldValueIRS element (for citing)
Total Community Benefit Expense46875TotalCommunityBenefitExpense
Direct Offsetting Revenue21466DirectOffsettingRevenue
Net Community Benefit Expense25409NetCommunityBenefitExpense
Percent Of Total Expense0.00110PercentOfTotalExpense

Health Professions Education HealthProfessionsEducation

FieldValueIRS element (for citing)
Total Community Benefit Expense39800TotalCommunityBenefitExpense
Net Community Benefit Expense39800NetCommunityBenefitExpense
Percent Of Total Expense0.00180PercentOfTotalExpense

Total Other Benefits TotalOtherBenefits

FieldValueIRS element (for citing)
Total Community Benefit Expense86675TotalCommunityBenefitExpense
Direct Offsetting Revenue21466DirectOffsettingRevenue
Net Community Benefit Expense65209NetCommunityBenefitExpense
Percent Of Total Expense0.00290PercentOfTotalExpense

Total Community Benefits TotalCommunityBenefits

FieldValueIRS element (for citing)
Total Community Benefit Expense905162TotalCommunityBenefitExpense
Direct Offsetting Revenue628157DirectOffsettingRevenue
Net Community Benefit Expense277005NetCommunityBenefitExpense
Percent Of Total Expense0.01300PercentOfTotalExpense

Coalition Building CoalitionBuilding

FieldValueIRS element (for citing)
Total Community Building Expense5502TotalCommunityBuildingExpense
Net Community Building Expense5502NetCommunityBuildingExpense
Percent Of Total Expense0.00020PercentOfTotalExpense

Health Improvement Advocacy HealthImprovementAdvocacy

FieldValueIRS element (for citing)
Total Community Building Expense2250TotalCommunityBuildingExpense
Net Community Building Expense2250NetCommunityBuildingExpense
Percent Of Total Expense0.00010PercentOfTotalExpense

Workforce Development WorkforceDevelopment

FieldValueIRS element (for citing)
Total Community Building Expense2433TotalCommunityBuildingExpense
Direct Offsetting Revenue1000DirectOffsettingRevenue
Net Community Building Expense1433NetCommunityBuildingExpense
Percent Of Total Expense0.00010PercentOfTotalExpense

Total Total

FieldValueIRS element (for citing)
Total Community Building Expense10185TotalCommunityBuildingExpense
Direct Offsetting Revenue1000DirectOffsettingRevenue
Net Community Building Expense9185NetCommunityBuildingExpense
Percent Of Total Expense0.00040PercentOfTotalExpense
FieldValueIRS element (for citing)
Bad Debt Expense Reported0BadDebtExpenseReported
Bad Debt Expense$558,209BadDebtExpenseAmount
Amount Attributable To172040AmountAttributableTo
Amount Reimbursed By Medicare10044748AmountReimbursedByMedicare
Cost Of Care Reimbursed By Medicare10394803CostOfCareReimbursedByMedicare
Medicare Surplus Or Shortfall-350055MedicareSurplusOrShortfall

Costing Methodology Used CostingMethodologyUsed

FieldValueIRS element (for citing)
Cost To Charge RatioXCostToChargeRatio
FieldValueIRS element (for citing)
Written Debt Collection Policy1WrittenDebtCollectionPolicy
Provision For Charity Care1ProvisionForCharityCare

Form990 Schedule H Part V Form990ScheduleHPartV (6 entries)

Address Line1Address/AddressLine1CityAddress/CityStateAddress/StateZIP CodeAddress/ZIPCodeLicensed HospitalLicensedHospitalGeneral Medical And SurgicalGeneralMedicalAndSurgicalCritical Access HospitalCriticalAccessHospitalEr24 HoursEr24HoursOtherOther
West River Health Services
1000 Highway 12HettingerND58639XXXX
New England Clinic
820 2nd Avenue WestBowmanND58647Certified Clinic
Bowman Clinic
608 Hwy 12 WestBowmanND58623Certified Clinic
Scranton Clinic
211 Main StreetScrantonND58653Certified Clinic
Mott Clinic
420 Pacific AvenueMottND58646Certified Clinic
Lemmon Clinic
401 6th Avenue WestLemmonSD57638Certified Clinic

Form990 Schedule H Part VI Form990ScheduleHPartVI

FieldValueIRS element (for citing)
Costing Method UsedPart I, Line 7: The organization used Worksheet 2 to determine the cost for Part III, Line 7, Rows a through c. The organization used actual expenses to determine the cost for Part I, Line 7, Rows e and f.CostingMethodUsed
Percent Of Total Expense ExplnPart I, Line 7f: The amount of bad debt included on Form 990, Part IX, line 25, column (A), but subtracted for purposes of calculating the percentage on this line is $905,468.PercentOfTotalExpenseExpln
Bad Debt FootnotePart III, Line 4: Footnote to organization's financial statements that describes bad debt expense:The carrying amount of patient and resident receivables is reduced by a valuation allowance that reflects management's estimate of amounts that will not be collected from patients, residents, and third-party payors. Management reviews patient and resident 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 and residents due to bad debts. Management considers historical write off and recovery information in determining the estimated bad debt provision.Bad debt expense was converted to cost using the cost to charge ratio calculated using Worksheet 2.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 $172,040. This is an estimation of the bad debts that would be eligible for the charity care policy if the patients applied.BadDebtFootnote
Shortfall As Community BenefitPart III, Line 8: The full amount of Medicare shortfall should be regarded as community benefit.West River Health Service's mission is to provide care to anyone regardless of their ability to pay. As such, they provide services to Medicare patients even though they know in many cases they will not recover their full margin on this work. Providing services under the Medicare program regardless of making an operating margin increases access to healthcare services, which is a community benefit.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 CMS.ShortfallAsCommunityBenefit
Debt Collection PolicyPart III, Line 9b: 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.DebtCollectionPolicy
Number Of Facility Type ExplnPart V: Part VI, Line 1: In relation to Part V, WRHS also has one podiatry center located in Dickinson, ND that is not required to be licensed under the state law. Because it does not have this requirement it was excluded from Part V Facility Information.NumberOfFacilityTypeExpln
General ExplanationPart I, Line 7e - Community Health Improvement Services and Community Benefit Operations: Fitness Center: Description of Activity: This is a fitness center located offsite from the main campus. Access to the center is by card key membership which is open to anyone within community and surrounding communities. The center is staffed approximately 24 hours/week; however, the therapy services inhabit space in the same building and are available Monday through Friday during normal work hours to supervise and/or maintain fitness center equipment in good working order. The center is equipped with several pieces of fitness equipment (recumbant bikes, tread mills, etc.). Currently,there are approximately 100 active memberships. Need for Activity: It has been determined through organized community group meetings that a need for a fitness center exists within the community. WRHS has had representation to those community meetings and volunteered to subsidize this activity as part of its mission to provide health and wellness services to the communities it serves. The fitness center has been in existence since 2005; however, over the years, the center has expanded its operations to include several new equipment pieces in effort to meet the needs of the community group. Physical and occupational therapy staff are also very closely involved and advise/monitor exercise programs for patients who have been through a therapy program. Objectives: Improve access to fitness and exercise programs, provide fitness and exercise programs at a nominal membership fee, address state and national initiatives on obesity and other health priorities, advance education and knowledge to the general public on importance of exercise and fitness in personal health.Total Community Benefit Expense $15,147Direct Offsetting Revenue $8,047Net Community Benefit Expense $7,100 Free Health-Related Brochures to Public: Description of Activity: Informational brochures on specific illnesses and diseases are provided to patients both in the hospital and clinic settings. These brochures contain up-to-date and vital information for patient on how to manage a disease/illness as has been determined by physician. Need for Activity: Need and desire for more information has been expressed by patients on return of patient satisfaction surveys. Objectives: Improve access to specific health-related information for patients, advance education and knowledge to the general public. Total Community Benefit Expense $2,423Net Community Benefit Expense $2,423 Medical Library: Description of Activity: Although a very small medical facility, WRHS has long subsidized the maintenance of a medical library available to staff, medical staff, and the general public. The library contains modern medical journals and periodicals as well as Consult and MDLearn software programs on two computers available for public use. The library is used extensively not only by medical staff but also by medical students and high school students as they prepare for science fair projects for medically-related research projects. The library is open 24x7 and is staffed for 24 hours/week. Need for Activity: There has been a long history of collabarative effort between the Hettinger Public School and WRHS. The School has encouraged its students to use the medical library and to work with professional staff as they do their research and/or consider careers in the medical field. Objectives: Improve access to the public on health-related information, advance education and knowledge to high school level students as they do research and plan for careers in the medical field, encourage collaborative efforts between the local school and medical professionals.Total Community Benefit Expense $4,015 (this is cost of periodicals/software calculated at 50% public use; all staff costs are also excluded)Net Community Benefit Expense $4,015 Medication Assistance: Description of Activity: The medication assistance program is a program subsidized by the hospital for the benefit of the general public. Began several years under the auspices of a federal grant, this program is designed to assist any and all individuals with enrollment in Medicare Part D as well as to work hand in hand with interested patients in obtaining medications and other pharmaceuticals from drug companies at reduced rates. Eligible patients must meet specified income guidelines to apply for and be deemed eligible for the reduction. There is a charge of $30 per quarter for those on the program. However, this cost does not fully cover the costs of program administration. There are approximately 60 individuals taking part in this program currently. Need for Activity: This need originated largely as part of a statewide endeavor to place community resource coodinators into each community across the state. Assessment surveys conducted at that time found a great need for this service in the rural areas of the state. Medicare Part D enrollment and continuance in the program can be very confusing for the elderly and the need to assist is evident. Objectives: Assist elderly population in Medicare Part D enrollment, provide assistance to eligible population in applying for and obtaining medications and other pharmaceuticals at a discount from retail, provide education and/or assistance in enrollment to other financial assistance programs.Total Community Benefit Expense $16,600Direct Offsetting Revenue $8,419Net Community Benefit Expense $8,181 General Screening/Flu Injection Administration: Description of Activity: One of the most attended events in the rural communities served by WRHS are the annual Farm and Home Shows. These Shows are held in three communities each fall--Hettinger, Lemmon, and Bowman. WRHS sends 3-5 staff to man booths at each Show. This staff will answer general health questions for the public, take free blood pressures, and administer flu vaccine to those interested. There is a charge of $20 for those receiving flu vaccine and/or WRHS will offer to submit a claim to insurance if the patient is interested. Approximately 250 people took advantage of the flu vaccine administration for this report period. Need for Activity: The need for flu vaccine and administration thereof is a public and national initiative to improve patient health and prevent spread of serious and contagious flu strains. The need for this activity has been widely proclaimed. The public has expressed appreciation for having this available on an annual basis. Objectives: A healthier community through administration and disease prevention, provide education on adverse effects if not immunized, prevent contagion of flu within the immediate and surrounding communities.Total Community Benefit Expense $7,285Direct Offsetting Revenue $5,000Net Community Benefit Expense $2,285 Standby Ambulance Services: Description of Activity: The local ambulance service provides a standby ambulance and two EMS staff at all Hettinger football games, rodeos, and demolition derbies. In addition, they are on call for all high school basketball, wrestling, and volleyball matches in case of emergency injuries. In this reporting period, there were ten events at which standby ambulance was made available. These services are provided free of charge to the community. Need for Activity: School officials and the community recognize the risk associated with any contact sport, espeically that of football, rodeo or derbies. It has been the longstanding tradition of WRHS to provide these services without charge to these not-for-profit entities. Objectives: Provide emergency and trauma care to participants of area sports, support local sports activities with encouragement toward safety.Total Community Benefit Expense $1,125Net Community Beneft Expense $1,1254th Of July Parade: Description of Activity: WRHS provided bottles of water for the parade.Total Community Benefit Expense $280Net Community Beneft Expense $280GeneralExplanation
Needs AssessmentPart VI, Line 2: There is representation from across the multi-county region on the WRHS board of directors; board members routinely provide feedback to administration and board of directors of the perceived health care needs within their respective communities.Board members and medical staff are brought together at the annual board retreat, at which time health care needs are discussed and become part of the strategic long-range planning process. This discussion will serve as the basis for health care strategic and action planning to develop health policies, allocate resources, improve or expand existing services, implement new programs and collaborate with other community health care providers. 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 community needs to administration and board of directorsWhile it has been several years since the last formal community needs assessment, WRHS is scheduled to conduct its next needs assessment in early 2011. Intent then is to continue this assessment every three years.WRHS conducts regular satisfaction surveys with patients who have received hospital/clinic services with WRHS. As part of that survey, patients are asked for their input for improvement and/or suggest other needed services.WRHS identifies unmet community health needs by participating in community coalitions, partnerships, boards, committees, advisory groups, and panels. Based on the above-noted assessment measures, the major community needs identified for 2009 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 and by building a better system of care for the uninsured; 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.NeedsAssessment
Patient Education AssistancePart VI, Line 3: It is the mission of 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 at the point of admission that 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 the 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.PatientEducationAssistance
Community InformationPart VI, Line 4: Hettinger is located in rural southwestern North Dakota and borders the states of South Dakota and Montana. The City has a population of 1,307 with a total population of 2,593 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 37,000 people over a 25,000 square mile inclusive of the counties named. The average household income for these counties is $27,935, which is considerably below the North Dakota average of $34,604. Twenty-two percent of the population in all counties served is 65 years of age or older. Four hundred twenty eight families within the service area fall below the federal poverty guidelines for an average of 12.28%. The North Dakota average for families falling below poverty levels is 8.3%. 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 3.4% of all patients served are Medicaid recipients and 5.5% 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.CommunityInformation
Community Building ActivitiesPart 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 person who are poor or uninsured.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. They also are actively involved in statewide initiatives to assure that WRHS and its partners are prepared in event of natural or manmade disasters. The flood of 2009 was a prime example of their involvement as they helped to develop procedures and protocol to follow in this natural disaster event. Included to the representation from WRHS are two representatives of the Quality Assurance/Quality Improvement Staff and the Disaster Management Coordinator for WRHS. In this reporting period, the following costs were realized for this community building effort.* Three staff met for 6 consecutive months of discussion/collaborative efforts with the Adams County Emergency Operations Center staff. Direct costs for this period were $688; indirect costs were $172. Total was $860.* Three staff met in regular monthly meetings over the year with the Southwest Region Disaster Management Team. Their goal was to develop a collaborative effort for disaster management that could be served throughout the region, to develop protocol for disaster management, and to educate other providers with disaster management protocol and guidelines. Direct costs for this period were $2,063; indirect costs were $516. Total was $2,579.* Three staff met for a period of six weeks (2 times a week) in teleconferences with the Statewide Disaster Management Team. Here they offered input to statewide disaster management protocol and took part in several table and field drills as preparation for natural or manmade disasters. Direct costs for this period were $1,650; indirect costs were $413. Total was $2,063.Grand total of this coalition-building effort is $5,502. There was no direct offsetting revenue to this project. The coalition efforts still continue today.Line 7 - Community Health Improvement AdvocacyHettinger has a locally-owned radio station. This station has a program called TTO (This, That, and Other Things). This program airs daily; WRHS has a designated hour per month to share information about the facility and promote general health and well-being. There have been six such programs over the past year in which staff went on TTO to inform of importance of flu vaccination, precautions for dealing with flu and other diseases, and other disease-specific cautions. Direct costs for staff to prepare and participate in the talk show were $1,800; indirect costs were $450. Total was $2,250.Line 8 - Workforce DevelopmentUnlike many parts of the State or across the nation, Hettinger and its community clinic sites are facing a burdensome manpower shortage. 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 of education and, particularly, of efforts for "growing" a clientele that will hopefully return to the area for permanent jobs at sometime in the future. In this past year, WRHS was the organizer as well as a participator in a SCRUBS camp for area schools. Several area communities participated in the one-day event and offered students a perspective on health careers and assistance available to them if they chose to forward their education in a medical field. This was a very successful event and well over 300 students were in attendance. Twelve staff from WRHS attended the camp and manned booths to answer questions and give specific information on careers in the health field. Direct costs for staff to participate were $1,946; indirect costs were $487. Total was $2,433. $1,000 of these costs were offset by a regional grant for advancement of health care careers.CommunityBuildingActivities
Other InformationPart VI, Line 6: 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. 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 our 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. 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. 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. For more information about WRHS, visit www.wrhs.com.OtherInformation
Affiliated Health Care SystemPart VI, Line 7: Part VI, Line 8: NoneAffiliatedHealthCareSystem

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Compensation CommitteeXCompensationCommittee
Compensation SurveyXCompensationSurvey
Board Or Committee ApprovalXBoardOrCommitteeApproval
Severance Payment0SeverancePayment
Supplemental Nonqual Retire Plan0SupplementalNonqualRetirePlan
Equity Based Comp Arrangement0EquityBasedCompArrangement
Comp Based On Revenue Of Filing Org0CompBasedOnRevenueOfFilingOrg
Comp Based On Revenue Related Orgs0CompBasedOnRevenueRelatedOrgs
Comp Based Net Earnings Filing Org0CompBasedNetEarningsFilingOrg
Comp Based Net Earnings Relate Orgs0CompBasedNetEarningsRelateOrgs
Any Non Fixed Payments0AnyNonFixedPayments
Initial Contract Exception0InitialContractException

Form990 Schedule J Part II Form990ScheduleJPartII

Name Business NameBusiness

FieldValueIRS element (for citing)
Business Name Line1Jim LongBusinessNameLine1
FieldValueIRS element (for citing)
Base Compensation Filing Org143114BaseCompensationFilingOrg
Comp Based On Related Orgs0CompBasedOnRelatedOrgs
Bonus Filing Org0BonusFilingOrg
Bonus Related Orgs0BonusRelatedOrgs
Other Compensation Filing Org0OtherCompensationFilingOrg
Other Compensation Related Orgs0OtherCompensationRelatedOrgs
Deferred Comp Filing Org10293DeferredCompFilingOrg
Deferred Comp Related Orgs0DeferredCompRelatedOrgs
Nontaxable Benefits Filing Org7524NontaxableBenefitsFilingOrg
Nontaxable Benefits Related Orgs0NontaxableBenefitsRelatedOrgs
Total Compensation Filing Org160931TotalCompensationFilingOrg
Total Compensation Related Orgs0TotalCompensationRelatedOrgs
Comp Report Prior990 Filing Org0CompReportPrior990FilingOrg
Comp Report Prior990 Related Orgs0CompReportPrior990RelatedOrgs

Form990 Schedule J Part III Form990ScheduleJPartIII

FieldValueIRS element (for citing)
IdentifierSupplemental InformationIdentifier
Return ReferencePart IIIReturnReference
ExplanationDr John Joyce is paid by United Clinic Physicians, an unrelated organization. Compensation information was unavailable from them for purposes of this return.Explanation

Schedule K IRS990ScheduleK

Form990 Schedule K Part I Form990ScheduleKPartI

Issuer Name IssuerName

FieldValueIRS element (for citing)
Business Name Line1City of Hettinger North DakotaBusinessNameLine1
FieldValueIRS element (for citing)
Issuer EIN456002094IssuerEIN
Date Issued2008-01-31DateIssued
Issue Price5275000IssuePrice
Description Of PurposeExpand & renovate hospital/Hettinger Clinic & acquisition of fixed eqpt.DescriptionOfPurpose
Defeased0Defeased
On Behalf Of Issuer0OnBehalfOfIssuer

Form990 Schedule K Part II Form990ScheduleKPartII

FieldValueIRS element (for citing)
Total Proceeds5275000TotalProceeds
Issuance Costs From Proceeds105500IssuanceCostsFromProceeds
Capital Expenditures5169500CapitalExpenditures
Year Of Subst Completion2010YearOfSubstCompletion
Current Refunding0CurrentRefunding
Advance Refunding0AdvanceRefunding
Final Allocation Made1FinalAllocationMade
Adequate Books And Recds Maintaind1AdequateBooksAndRecdsMaintaind

Form990 Schedule K Part III Form990ScheduleKPartIII

FieldValueIRS element (for citing)
Owning Bond Financed Property0OwningBondFinancedProperty
Any Lease Arrangements0AnyLeaseArrangements
Mngment Cntrct Bond Financd Prprty0MngmentCntrctBondFinancdPrprty
Any Research Agreements0AnyResearchAgreements
Bond Counsel Routinely Engaged0BondCounselRoutinelyEngaged
Prcntge Prvt Business Use By Others0.00000PrcntgePrvtBusinessUseByOthers
Percentage Of Prvt Business Re UBI0.00000PercentageOfPrvtBusinessReUBI
Total Private Business Use0.00000TotalPrivateBusinessUse
Post Issuance Compliance Procdrs1PostIssuanceComplianceProcdrs

Form990 Schedule K Part IV Form990ScheduleKPartIV

FieldValueIRS element (for citing)
Form8038 T Filed0Form8038TFiled
Variable Rate Issue1VariableRateIssue
Hedge Identified In Books And Recds0HedgeIdentifiedInBooksAndRecds
Gross Proceeds Invested In GIC0GrossProceedsInvestedInGIC
Gross Proceeds Invested0GrossProceedsInvested
Exception To Rebate0ExceptionToRebate

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (8 entries)

IdentifierIdentifierExplanationExplanation
Form 990, Part VI, Section A, line 6West River Health Services Foundation is the sole member of the organization. West River Health Services board members are appointed by West River Health Services Foundation.
Form 990, Part VI, Section A, line 7aAs the sole member, The WRHS Foundation appoints the board members of WRHS.
Form 990, Part VI, Section A, line 7bAs sole member, WRHS Foundation approves all amendments to the Articles of Incorporation and Bylaws, approves debt when it excess levels set by the board of directors of the Foundation, 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 11The CFO and CEO will review the Form 990 prior to the completed Form 990 being distributed and reviewed by board members at their regular meeting.
Form 990, Part VI, Section B, line 12cAll 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 15CEO: 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 use comparable data in setting compensation for each level of employee. Compensation was last reviewed in April of 2009.
Form 990, Part VI, Section C, line 19Administrative 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 10 hours at Western Horizons Living Center (WHLC) and 2 hours at the West River Health Services Foundation (WRHSF); Jim Long serves an additional 4 hours at WHLC and 2 hours at WRHSF. Dr John Joyce's compensation is paid by United Clinic Physicians. Compensation information was unavailable from them for purposes of this return.

Schedule R IRS990ScheduleR

Form990 Schedule R Part II Form990ScheduleRPartII (2 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINPrimary ActivitiesPrimaryActivitiesLegal Domicile StateLegalDomicileStateExempt Code SectionExemptCodeSectionPublic Charity StatusPublicCharityStatusBusiness Name Line1DirectControllingEntityName/BusinessNameLine1Direct Controlling Entity NADirectControllingEntityNA
Western Horizons Living Centers
1104 Highway 12HettingerND58369260794602Long-term care/assisted living servicesND501(c)(3)9West River Health Services Foundation
West River Health Services Foundation
1000 Highway 12HettingerND58639450411825FundraisingND501(c)(3)11aN/A
FieldValueIRS element (for citing)
Receipt Of Int Ann Rents Royalties0ReceiptOfIntAnnRentsRoyalties
Gift Grant Or Cap Contr To Other Org0GiftGrantOrCapContrToOtherOrg
Gift Grant Or Cap Contr Fr Other Org1GiftGrantOrCapContrFrOtherOrg
Loans Or Guarantees To Other Org0LoansOrGuaranteesToOtherOrg
Loans Or Guarantees From Other Org0LoansOrGuaranteesFromOtherOrg
Sale Of Assets To Other Org0SaleOfAssetsToOtherOrg
Purchase Of Assets From Other Org0PurchaseOfAssetsFromOtherOrg
Exchange Of Assets0ExchangeOfAssets
Rental Of Facilities To Other Orgs1RentalOfFacilitiesToOtherOrgs
Rental Of Facilities Fr Other Orgs0RentalOfFacilitiesFrOtherOrgs
Perform Of Services For Other Orgs0PerformOfServicesForOtherOrgs
Perform Of Services By Other Orgs0PerformOfServicesByOtherOrgs
Sharing Of Facilities1SharingOfFacilities
Sharing Of Paid Employees1SharingOfPaidEmployees
Reimbursement Paid To Other Org0ReimbursementPaidToOtherOrg
Reimbursement Paid By Other Org1ReimbursementPaidByOtherOrg
Other Transfer To Other Org0OtherTransferToOtherOrg
Other Transfer From Other Org0OtherTransferFromOtherOrg