2024-11-11T14:40:26-06:00 2023-12-31 450250958 Eide Bailly LLP 4585 Coleman St Ste 200 Bismarck ND 58503 990 2023-01-01 450458242 Southwest Healthcare Services SOUT 7015235555 802 2nd St NW Bowman ND 58623 Dennis Goebel CEO 7015235555 2024-11-11 1 1 Lisa Chaffee CPA P00193453 7012551091 2024-11-11 2023 2024-10-15 13:58:12Z Dennis Goebel 802 2nd St NW Bowman ND 58623 17303234 0 X www.swhealthcare.net X 2000 ND Southwest Healthcare Services is organized to provide quality health care services. 9 7 171 150 0 0 889451 1364967 13964863 15824025 33207 59665 3951 54577 14891472 17303234 0 0 0 0 7372364 6744037 0 0 4156 8719382 10276260 16091746 17020297 -1200274 282937 33427348 32662455 27432478 26090919 5994870 6571536 X Guided by faith-based leadership, we are a family of specialists, each performing a unique service. With a spirit of compassion, we provide excellence in healthcare to those we are privileged to serve. 1 0 14574991 15878602 Located in Bowman, North Dakota, Southwest Healthcare Services' Mission Statement is "Guided by Faith, we provide excellent care for those we are privileged to serve!". We operate a 35-bed critical access hospital, offering a range of outpatient services including lab work, radiology, and various therapies. Additionally, we support the community with a rural health clinic, 12-unit assisted living facility, 12-unit independent living apartment complex, and ambulance services. We provide care to our long-term nursing home residents in our Swingbed unit. Southwest Healthcare Services is a private, nonprofit organization dedicated to providing quality healthcare for over 5,500 residents in seven rural communities in the southwest corner of North Dakota and the northwest corner of South Dakota. Southwest Healthcare Services operates a full-time emergency room and provides emergency care regardless of ability to pay. The facility has achieved Level IV Trauma designation with physician staffed emergency services available 24 hours a day, seven days a week. Our organization is one of the most important economic assets in the region. Services provided in 2023 demonstrated the strong need for Southwest Healthcare Services. Our rural health clinic had over 6,273 patient encounters and the hospital recorded 754 emergency room visits.Southwest Healthcare Services also provides non-emergency services to the community making these services accessible to the community through participation in government programs like Medicare and Medicaid and our own charity care program. Services are provided to all individuals regardless of individual status. Southwest Healthcare Services charity care program provides discounted and free services to patients that are unable to be fully responsible for the cost of the health care they receive. We are committed to responding to the increasing number of patients who are under-insured or without insurance and who need to seek healthcare services at our facility. To fulfill its mission of community service, we provide care to these patients who meet certain criteria under its charity care policy without charge or at amounts less than its established rates. Because we do not pursue collection of amounts determined to qualify as charity care, they are not reported as patient and resident service revenue. The estimated cost of providing charity care for the year ended December 31, 2023 was $98,000 calculated by multiplying the ratio of cost to gross charges by the gross uncompensated charges associated with providing charity care to its patients and residents. 14574991 1 1 0 0 0 0 0 0 1 1 1 0 0 0 1 1 1 0 0 0 0 0 0 0 0 0 1 1 0 0 1 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 1 45 0 1 171 1 0 0 0 0 0 0 0 0 0 0 0 0 X 9 7 0 0 0 0 0 0 0 1 0 0 0 1 1 1 1 1 1 1 1 0 X Amanda Loughman CFO 7015233214 802 2nd St NW Bowman ND 58623 Christine Peterson NP Trustee 40.00 X 177288 0 0 Teran Doerr President (Jan-Jun) 1.00 X X 0 0 0 Andrew Weiss-Vice President (Jan-Jun)/President (Jul-Dec) 1.00 X X 0 0 0 Jordan Anderson Secretary (Jan-Jun)/Vice President (Jul-Dec) 1.00 X X 0 0 0 Laurie Braaten-Trustee (Jan-Jun)/Secretary (July-Dec) 1.00 X X 0 0 0 Chanell Walby Trustee 1.00 X 0 0 0 Breanne Beylund Trustee (Jul-Dec) 1.00 X 0 0 0 Anne Gruber Trustee (Jul-Dec) 1.00 X 0 0 0 Wendy Stuber Trustee 1.00 X 0 0 0 Connie Gaebe Trustee 1.00 X 0 0 0 Dennis Goebel CEO 40.00 X 221314 0 13194 Amanda Loughman CFO 40.00 X 116082 0 10836 Tim Adams Physician 40.00 X 334677 0 0 Roy Cordy Physician 40.00 X 379148 0 0 Kurt Datz Physician 10.00 X 120001 0 0 Jessica Erickson Pharmacist 40.00 X 121056 0 9000 Patricia Gilbert Physicians Assistant 40.00 X 136889 0 0 1606455 0 33030 9 0 1 0 Homestead Recruiters Inc 821 Senior Ave Dickinson ND 58601 Nursing Coverage 753208 TM Nursing LTD 2594 Canale Tagg Cove Germantown TN 38138 Nursing Coverage 496883 Signature Staff Resources LLC 1460 T L Townsend Dr 104 Rockwall TX 75032 Nursing Coverage 489700 Roy Cordy MD 2100 S Ocean Dr 14G Fort Lauderdale FL 33316 Physician Coverage 379148 E R Gard Corp PO Box A Bowman ND 58623 Physician Coverage 334677 11 1364967 1364967 Patient & Resident Service Revenu 621110 14898352 14898352 Pharmacy Revenue 456110 834870 834870 Supporting Revenue 900099 90803 90803 15824025 44968 44968 7297 7400 0 0 7297 7400 14697 14697 1512 0 1512 1512 Insurance Proceeds 900099 53065 53065 53065 17303234 15878602 0 59665 X 565713 182562 383151 87232 47944 39288 5034872 4430038 604834 642777 543425 99352 413443 343486 69957 34378 34378 74494 74494 4727315 4437705 289610 100046 100046 311518 245532 65986 376963 376963 356264 318991 37273 74039 61021 13018 695 695 442178 442178 2246202 2118693 127509 109772 109772 Medical Supplies 1196166 1196166 Dietary Food and Supple 170930 170930 Dues Licensing & Subscr 34254 34254 Dues & Subscriptions 14642 14642 6404 2066 182 4156 17020297 14574991 2441150 4156 466132 2416857 3535 0 2110795 2428630 352234 373998 187927 126785 49341861 25873946 25207342 23467915 2510718 2637108 2588665 1211162 33427348 32662455 1314348 1082024 23599 23885 25789205 24787214 305326 197796 27432478 26090919 X 5121673 5492513 873197 1079023 5994870 6571536 33427348 32662455 X 282937 107281 186448 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 1 18815 7501 4156 22160 1 X 102225 16033 118258 127112 -24887 102225 127112 14308 14308 127112 127112 10556 10556 127112 127112 13595 13595 127112 0.00000 1.00000 0.00000 1 0 75488 75488 41287158 19388212 21898946 7979215 6485734 1493481 23467915 Right of Use Liability 197796 197796 X 17592807 107281 189793 297074 17295733 7501 7501 17303234 17016141 0 17016141 4156 4156 17020297 Part IV, Line 1b: Southwest Healthcare Services has an auxiliary that operates under the same EIN as Southwest Healthcare Services. Part IV, Line 2b: Southwest acts as custodian for the funds of residents. These funds are included in cash and accounts payable in the financial statements. Resident trust funds totaled $1,219 and $934 and assisted living security deposits totaled $22,666 and $22,665 at December 31, 2023 and 2022. Part V, Line 4: Endowments held and administered by Southwest Healthcare Services: The principal of $102,225 is permanently restricted. The earnings from the principal balance are for hospital operations and to support assisted living, as necessary. From time to time, certain donor-restricted endowment funds may have fair values less than the amounts required to be maintained by donors or law (underwater endowments). Southwest has interpreted UPMIFA to permit spending from underwater endowments in accordance with prudent measures required under law. At December 31, 2023, funds with original gift values of $127,112, fair values of $118,258 and deficiencies of $8,854 were reported in net assets with donor restrictions. Part X, Line 2: Southwest 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. Southwest 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 2d - Other Adjustments: Change in Sunrise Receivable 189,793. Part XI, Line 4b - Other Adjustments: Auxiliary Revenue 7,501. Part XII, Line 4b - Other Adjustments: Auxiliary Expenses 4,156. 1 1 X 1 X 1 X 1 1 1 0 1 1 98000 98000 0.00580 534774 308462 226312 0.01330 632774 308462 324312 0.01910 26380 3950 22430 0.00130 3809334 2268612 1540722 0.09050 3835714 2272562 1563152 0.09180 4468488 2581024 1887464 0.11090 3 100 23152 5625 17527 0.00100 3 100 23152 5625 17527 0.00100 1 194325 38865 5908812 5954727 -45915 X 1 1 1 1 Southwest Healthcare Services 14 6th Ave SW Bowman ND 58623 5006 X X X X Rural Health Clinic Southwest Healthcare Services 1 0 0 1 X X X X X X X X X 22 1 0 0 1 X http://swhealthcare.net/events/chna.html X See Part V, Section C X 1 22 1 http://swhealthcare.net/events/chna.html 0 1 X 100.000000000000 200.000000000000 X X X X X 1 1 X X X X 1 X See Part V, Section C X See Part V, Section C X See Part V, Section C X X X X X X 1 X 0 X X X X 1 X 0 0 Southwest Healthcare Services Part V, Section B, Line 5: A service area survey was available to all residents. Community leaders were chosen to represent the broad interests of the community and took part in one-on-one informant interviews. A community group was formed comprised of community leaders and area residents, including representation from the health community, business community, law enforcement, education, faith community, and social services agencies. This community group met to discuss and prioritize area health needs during two separate group meetings. Southwest Healthcare Services Part V, Section B, Line 11: The organization completed a new CHNA in 2022. The top four needs identified were: Availability of mental health services; attracting and retaining young families; not enough healthcare staff in general; depression and anxiety (all ages)Southwest Healthcare Services will continue to work on implementing all top identified needs as outlined in our implementation plan. Note that we grouped availability of mental health services and depression/anxiety together in our implementation plan.In August 2023, we started our outpatient behavioral health department. We started the program by reaching our geriatric population in the form of group therapy sessions. In the fourth quarter of 2023, we had six admissions to the program and 22 referrals. Based on a Geriatric Depression Scale after one year, we found that our patients had a decrease of 6.3 points on this scale at the time of discharge. This is used to assess the depressive symptoms in our older population and is considered a significant win.Throughout 2023, our main shortage in healthcare staff remains in the nursing department. We continue to research what other companies are doing to remain competitive. We are offering large sign-on bonuses, student loan repayment, and relocation. However, nursing still remains very difficult to recruit to a rural hospital. Overall, Southwest Healthcare Services hired 46 new employees in 2023.With the assistance of our local Chamber of Economic Development, Southwest Healthcare Services was able to attract some out-of-state employees to the area in 2023. We were able to recruit and relocate three employees to the community: a nurse's aide, a radiology technician, and a laboratory technician. We worked with an advisor that helped connect us with a lab technician from the Philippines. He is interested in staying in our small community and is working on becoming a permanent resident. Southwest Healthcare Services Part V, Section B, Line 13h: The Organization uses a Soft credit check. Also presumptive eligibility may be used to determine eligibility for financial assistance based on the individuals life circumstances that may include: 1. State funded prescription programs;2. Homeless or received care from a homeless clinic;3. Participation in Women, Infants and Children programs (WIC);4. Food stamp eligibility;5. Subsidized school lunch program eligibility;6. Eligibility for other state or local assistance program that areunfunded (e.g. Medicaid spend-down);7. Low income/subsidized housing is provided as a valid address; and8. Patient is deceased with no known estate. Southwest Healthcare Services Part V, Section B, Line 16j: A summary of the financial assistance policy and financial assistance contact information can be found at the admissions desk in the hospital, clinic, and online. The financial assistance application is also summarized on the back of our billing invoices. Part V, Section B, Line 7b: Ruralhealth.und.edu/projects/flex/hospitals#bowman Part V, Section B, Line 16a: http://swhealthcare.net/patient/financials/financial-assistance-policy.html Part V, Section B, Line 16b: http://swhealthcare.net/patient/financials/financial_assistance_form.html Part V, Section B, Line 16c: http://swhealthcare.net/patient/financials/assistance.html 4 1 - Southwest Healthcare Services 802 2nd St NW Bowman ND 58623 Independent Living and LTC 2 - Bowman Ambulance Services 111 Highway 12 W Bowman ND 58623 Ambulance Services 3 - Sunrise Village 203 11th Ave NW Bowman ND 58623 Assisted Living and Home Care 4 - Southwest Healthcare Clinic 12 6th Ave SW Bowman ND 58623 Rural Healthcare Clinic Part I, Line 3c: There are instances when a patient may appear eligible for financial assistance but the patient has failed to submit a Financial Assistance Application or an Application has been submitted but a proper determination cannot be made due to the lack of adequate information or supporting documentation. Often there is adequate information provided by the patient through other sources which could provide sufficient evidence to provide the patient with assistance. In the event there is no evidence to support a patient's eligibility for financial assistance, Southwest Healthcare Services could use outside agencies in determining estimated income amounts for the basis of determining financial assistance eligibility and potential discount amounts. Presumptive eligibility may be determined on the basis of individual life circumstances that may include:1. State funded prescription programs;2. Homeless or received care from a homeless clinic;3. Participation in Women, Infants and Children programs (WIC);4. Food stamp eligibility;5. Subsidized school lunch program eligibility;6. Eligibility for other state or local assistance program that are unfunded (e.g. Medicaid spend-down);7. Low income/subsidized housing is provided as a valid address; and8. Patient is deceased with no known estate. 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. Community health improvement services, line 7e, are reported based on actual expenseamounts recorded from the events in the general ledger. The costs for Medicaid reported on line 7b were determined using the Medicaid Cost report and the cost for subsidized health services reported on line 7g were determined using the Medicare Cost Report. Part II, Community Building Activities: Southwest Healthcare Services provides EMS staff support at public sporting events such as Motocross races, rodeos, and school sport activities. Support is also provided to the high school in the form of sports medicine for their sports activities. Part III, Line 2: The amount reported on line 2 represents implicit price concessions. Southwest determines its estimate of implicit price concessions based on its historical collection experience with this class of patients and residents. Part III, Line 3: Based on our review, it is safe to reasonably estimate that 20% of implicit price concessions is attributable to patients eligible under our charity care policy. If these individuals would have completed the paperwork required to obtain financial assistance, they may have qualified. Southwest Healthcare Services does not refuse service to patients that are unable to pay. This is evidence that the care is given for community benefit motivations. Part III, Line 4: The footnote to the Organization's financial statements can be found on page 13 and 14 of the attached audited financial statements. Part III, Line 8: IRS Rev. Rul. 69-545, which established the community benefit standard for nonprofit hospitals, states that if a hospital serves patients with government health benefits, including Medicare, then this is an indication that the hospital operates to promote the health of the community. In some communities, Medicare is the largest payer, and hospitals must accept these patients regardless of whether they make a surplus or deficit from providing such services. If the Medicare participation is premised on this fact, then providing Medicare services promotes access to healthcare services which is a community benefit. Also, the elderly are often an underserved population who experience issues with access to healthcare services. Without tax-exempt hospitals like Southwest Healthcare Services providing Medicare services, the government would bear the burden of directly providing services to the elderly.Medicare allowable costs were obtained from 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: Southwest Healthcare Services will not engage in extraordinary collection actions (ECA) before it makes a reasonable effort to determine whether a patient is eligible for financial assistance.Reasonable efforts shall include:1. Validating that the patient owes the unpaid bills and that all sources of third party payment have been identified and billed by the hospital;2. Documentation that the patient has been offered a payment plan but has not honored the terms of that plan;3. Documentation that Southwest Healthcare Services has offered and has attempted to offer the patient the opportunity to apply for financial assistance and that the patient has not complied with the hospital's application requirements;4. Documentation that Southwest Healthcare Services has exerted efforts to notify patients about an impending ECA. These efforts should include:a. Providing patients with a 30-day written notice before initiating collection activities. This 30-day written notice shall include a copy of the Financial Assistance Policy Plain Language Summary;b. Making oral attempts to contact patients, using their contact information on file, about an impending ECA as well as informing patients about the availability of Southwest Healthcare's Financial Assistance Policy;5. Providing for a Notification Period of 120 days from the date of the first post-discharge billing statement during which Southwest Healthcare is required to notify the patient of the availability of FinancialAssistance. ECAs may only start after this Notification Period has elapsed and no Financial Assistance has been submitted by the patient;6. Providing for an Application Period of 240 days from the date of the first post-discharge billing statement during which Southwest Healthcare is required to accept and deliberate on a Financial Assistanceapplication that a patient may submit, while taking into consideration the following:a. If a patient submits an incomplete application during the Application Period, Southwest Healthcare must:i. Suspend any ECAs already initiated;ii. Inform the patient by way of a written notice what additional information or documentation is required;iii. Provide the contact information of the Financial Counselor who may assist the patient in completing the Financial Assistance application;If the patient fails to provide the additional information or documentation after 30 days from notification, Southwest Healthcare may resume ECAs.b. If a patient submits a complete application during the Application Period, Southwest Healthcare must:i. Suspend any ECAs already initiated;ii. Determine whether the application meets the eligibility criteria for Financial Assistance.iii. Inform the patients within 30 days by way of a written notice of the result of the determination and the basis for the decision. Part VI, Line 2: In addition to completing a Community Health Needs Assessment every 3 years, Southwest Healthcare assesses health care needs of the community in the following ways: Satisfaction surveys are sent to patients and residents. Our department heads get together once a month to discuss issues or opportunities within their departments. Certain department heads also meet with the Board of Directors to discuss their departments and community health needs within the community. Health fairs are held within our service area. If any feedback is given from patients attending the health fair, it is brought to the attention of the administrator. Part VI, Line 3: A summary of our financial assistance policy and financial assistance contact information can be found at the admissions desk in the hospital, clinic, online, and on the back of our statements. Financial assistance contact information is included in patient bills and is discussed with patients as well as the availability of various government benefits, such as Medicaid or state programs. Patients are assisted with qualification for such programs where applicable. Employees who are responsible for registering patients are asked to consider/screen patients who may appear to qualify or who have asked about financial assistance. The registration clerk is to give the patient a brochure explaining the Financial Assistance program which contains information on how to access the Patient Financial Services Representative (PFS) to obtain assistance. Part VI, Line 4: The community is largely agriculturally based but in recent years the oil and gas industry has grown extensively. The growth in the oil and gas industries has increased the patient base that our organization serves. The city we reside in is located at an intersection of two main highways in the state of North Dakota. Southwest Healthcare Services is the largest employer in the city and serves an area that extends approximately 45 miles in all directions, North, South, East and West. There is one other rural health clinic in our city limits that is operated by another healthcare facility which is 40 miles from our city.Southwest Healthcare Services serves over 5,500 people in rural counties of Bowman and Slope, North Dakota, and Harding County in South Dakota. We have been very fortunate to have an unemployment rate in 2023 of 1.0% in Bowman County, 2.1% in Slope County and 2.1% in Harding County and a median income in 2021 of $69,437 for our service area. In 2023, approximately 29.2% of the persons under the age of 65 were without health insurance in our service area. Part VI, Line 5: Southwest Healthcare Services extends medical privileges to all providers in the community, and has a community board. Any surplus funds are used for investments in both capital assets, and medical equipment which improve services available as well as the quality of care that we give to the patients in our service area.Southwest Healthcare Services operates an emergency room available to all regardless of ability to pay. The Hospital participates in education and training of healthcare professionals and serves as a vehicle to attract and effectively use donated funds. Southwest Healthcare Services provides EMS staff support at public sporting events such as Motocross races, rodeos, and school sport activities. Support is also provided to the high school in the form of sports medicine for their sports activities. We do health fairs in 6 communities across our service area. We provide CPR and first aid classes to local coaches. We participate in job shadow events and career fairs. X X X X X 0 0 0 0 0 0 0 0 0 Roy Cordy Physician 379148 0 0 0 0 0 0 0 0 0 379148 0 0 0 Tim Adams Physician 334677 0 0 0 0 0 0 0 0 0 334677 0 0 0 Dennis Goebel CEO 221314 0 0 0 0 0 0 0 22194 0 243508 0 0 0 Christine Peterson NP Trustee 177288 0 0 0 0 0 0 0 9000 0 186288 0 0 0 Jason Anderson Jason is the brother of Board Member Jordan Anderson 65480 Compensation 0 Amber Anderson Amber is the wife of Board Member Jordan Anderson 21752 Compensation 0 Form 990, Part III, line 2 Our Behavioral Health department started in August 2023. Form 990, Part VI, Section A, line 1a The Board of Trustees may designate an Executive Committee composed of the President, Vice President and at least one other trustee designated by the Board of Trustees. Subject to the limitations prescribed by the North Dakota Century Code, the Executive Committee has the authority of the Board of Trustees in the management of the business of this corporation in the interval between meetings of the Board of Trustees and the Executive Committee is at all times subject to the control and direction of the Board of Trustees. Form 990, Part VI, Section A, line 8b The Organization has an Executive Committee, however no action was taken. Recommendations were taken to the full board of directors. Form 990, Part VI, Section B, line 11b The return is reviewed by the CFO during the process of completing the return. Once a draft is completed, a copy is distributed to the CEO and the Board of Directors to review and approve. If no concerns or corrections are presented during the approval process, the CFO approves the return to be filed, and the CEO signs the final return. Form 990, Part VI, Section B, line 12c All officers, directors, and key employees are required to complete a conflict of interest form annually. The forms are reviewed initially by the CEO for potential conflicts. Any actual conflicts are reviewed by the Board of Directors. A person with a conflict is restricted from voting on related matters. Form 990, Part VI, Section B, line 15 The CEO's performance review is completed by the Executive Team of the Board of Directors, comprised of the President, Vice President, and Secretary. In 2023, the CEO brought data from the North Dakota Compensation Salary Survey as well as an independent study completed by Eide Bailly. The CFO compiled other CEO wages from comparable North Dakota Critical Access Hospitals using publicly reported 990 data. The CEO made a recommendation of where his salary range should be based on years in his role and beforementioned data. The Executive Team reached a decision to increase the CEO's compensation based on all data provided. In 2023, the CEO brought a recommendation at the same time as his evaluation to do a one-time market increase for the CFO based on the North Dakota Compensation Salary Survey and her years of comparable service. The Executive Team on the Board of Directors approved this request. The CFO typically receives the same increase as all other staff every year. Form 990, Part VI, Section C, line 19 The Organization makes its governing documents, conflict of interest policy, and financial statements available to the public upon request. Form 990, Part IX, line 11g Purchased services & recruitment: Program service expenses 274,690. Management and general expenses 80,944. Fundraising expenses 0. Total expenses 355,634. Professional Fees & Consulting: Program service expenses 3,736,663. Management and general expenses 81,005. Fundraising expenses 0. Total expenses 3,817,668. Repairs & Maint/Service contracts &: Program service expenses 426,352. Management and general expenses 127,661. Fundraising expenses 0. Total expenses 554,013. Form 990, Part XI, line 9: Auxiliary Net Income -3,345. Change in Sunrise Receivable 189,793.