WEST RIVER HEALTH SERVICES FOUNDATION: Form 990, tax year 2021
View the entire original 990 at ProPublica ↗
- Organization
- WEST RIVER HEALTH SERVICES FOUNDATION (EIN 45-0411825)
- Tax period
- 2021-04-01 to 2022-03-31
- Filed
- 2023-02-14
- IRS object ID
- 202310459349302156
- Schema version
- 2021v4.2
- 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
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2023-02-14T15:01:14-06:00 | ReturnTs |
| Tax Period End | 2022-03-31 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 460403496 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CASEY PETERSON LTD | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 909 ST JOSEPH ST STE 101 | AddressLine1Txt |
| City | RAPID CITY | CityNm |
| State Abbreviation | SD | StateAbbreviationCd |
| ZIP | 57701 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2021-04-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 450411825 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | WEST RIVER HEALTH SERVICES FOUNDATION | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | WEST | BusinessNameControlTxt |
| Phone | 7015674561 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1000 HIGHWAY 12 | AddressLine1Txt |
| City | HETTINGER | CityNm |
| State Abbreviation | ND | StateAbbreviationCd |
| ZIP | 58639 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | NATHAN STADHEIM | PersonNm |
| Person Title | CFO | PersonTitleTxt |
| Phone | 7015674561 | PhoneNum |
| Signature | 2023-02-14 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Signing Officer SigningOfficerGrp
Person Full Name PersonFullName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person First | NATHAN | PersonFirstNm |
| Person Last | STADHEIM | PersonLastNm |
| Field | Value | IRS element (for citing) |
|---|---|---|
| SSN | 999009999 | SSN |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | KAYLA GIESEY CPA | PreparerPersonNm |
| PTIN | P01874520 | PTIN |
| Phone | 6053481930 | PhoneNum |
| Preparation | 2023-02-14 | PreparationDt |
Additional Filer Information AdditionalFilerInformation
Trusted Customer TrustedCustomerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Trusted Customer | 3 | TrustedCustomerCd |
| Authentication Assurance Level | AAL1 | AuthenticationAssuranceLevelCd |
| Identity Assurance Level | IAL1 | IdentityAssuranceLevelCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2021 | TaxYr |
| Build TS | 2023-03-07 01:45:13Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | ALYSON KORNELE | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1000 HIGHWAY 12 | AddressLine1Txt |
| City | HETTINGER | CityNm |
| State Abbreviation | ND | StateAbbreviationCd |
| ZIP | 58639 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $1,399,787 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | WWW.WRHS.COM | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1982 | FormationYr |
| Legal Domicile State | ND | LegalDomicileStateCd |
| Activity Or Mission | SUPPORT WEST RIVER HEALTH SERVICES AND WESTERN HORIZONS LIVING CENTER AS THEY PROVIDE COMPREHENSIVE HEALTH AND WELLNESS SERVICES TO THE REGION BY PROVIDING FUNDRAISING AND DEVELOPMENT SERVICES. | ActivityOrMissionDesc |
| Voting Members Governing Body | 8 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 5 | VotingMembersIndependentCnt |
| Total Employee | 0 | TotalEmployeeCnt |
| Total Volunteers | 0 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $260,560 | PYContributionsGrantsAmt |
| CY Contributions Grants | $266,344 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $0 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $0 | CYProgramServiceRevenueAmt |
| PY Investment Income | $198,304 | PYInvestmentIncomeAmt |
| CY Investment Income | $395,536 | CYInvestmentIncomeAmt |
| PY Other Revenue | $54,102 | PYOtherRevenueAmt |
| CY Other Revenue | $48,207 | CYOtherRevenueAmt |
| PY Total Revenue | $512,966 | PYTotalRevenueAmt |
| CY Total Revenue | $710,087 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $173,695 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $154,014 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $340 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $430 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $169,302 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $212,686 | PYOtherExpensesAmt |
| CY Other Expenses | $216,151 | CYOtherExpensesAmt |
| PY Total Expenses | $386,721 | PYTotalExpensesAmt |
| CY Total Expenses | $370,595 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $126,245 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $339,492 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $5,919,833 | TotalAssetsBOYAmt |
| Total Assets EOY | $6,071,318 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $108,154 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $119,326 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $5,811,679 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $5,951,992 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | THE MISSION OF WEST RIVER HEALTH SERVICES FOUNDATION IS TO SUPPORT WEST RIVER HEALTH SERVICES AND WESTERN HORIZONS LIVING CENTER AS THEY PROVIDE COMPREHENSIVE HEALTH AND WELLNESS SERVICES TO THE REGION BY PROVIDING FUNDRAISING AND DEVELOPMENT SERVICES. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $154,014 | ExpenseAmt |
| Grant | $154,014 | GrantAmt |
| Revenue | $0 | RevenueAmt |
| Desc | THE FOUNDATION WAS INCORPORATED IN 1982 TO SERVE AS A SOURCE OF CONTRIBUTED FUNDS FOR WEST RIVER HEALTH SERVICES WITH THE ADDITION OF WESTERN HORIZONS LIVING CENTERS IN SEPTEMBER OF 2007. THE FOUNDATION IS GOVERNED BY A VOLUNTEER BOARD OF DIRECTORS, IS REGISTERED AS A 501(C)(3) U.S. CHARITABLE ORGANIZATION, AND IS LICENSED BY THE STATE OF NORTH DAKOTA. THE FOUNDATION EXISTS TO RAISE FUNDS FOR NEW EQUIPMENT AND TECHNOLOGY; DEVELOP NEW HEALTH-RELATED PROGRAMS AND SERVICES; ENHANCE ASSISTED LIVING AND LONG-TERM CARE SERVICES; SUPPORT COMMUNITY WELLNESS EDUCATION; AND PROVIDE SCHOLARSHIPS AND LOANS FOR NURSING, ALLIED HEALTHCARE PROFESSIONALS, AND PHYSICIANS TO MEET THE CONTINUING CHANGES IN HEALTHCARE REFORM. TO REACH THESE GOALS, AN ENDOWMENT FUND WAS ESTABLISHED. THE ENDOWMENT FUND WILL BE USED AS A PERMANENT FUNDING SOURCE FOR WRHS AND WHLC TO CARRY OUT THEIR VISIONS OF ENSURING QUALITY HEALTH AND LONG-TERM CARE SERVICES TO THE CITIZENS OF THE REGION. | Desc |
| Total Program Service Expenses | $154,014 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (1) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (1) | ScheduleBRequiredInd |
| Political Campaign Acty | 0 | PoliticalCampaignActyInd |
| Lobbying Activities | 0 | LobbyingActivitiesInd |
| Subject To Proxy Tax | 0 | SubjectToProxyTaxInd |
| Donor Advised Fund | 0 | DonorAdvisedFundInd |
| Conservation Easements | 0 | ConservationEasementsInd |
| Collections Of Art | 0 | CollectionsOfArtInd |
| Credit Counseling | 0 | CreditCounselingInd |
| Donor Rstr Or Quasi Endowments | Yes (1) | DonorRstrOrQuasiEndowmentsInd |
| Report Land Building Equipment | Yes (1) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | 0 | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | 0 | ReportProgramRelatedInvstInd |
| Report Other Assets | 0 | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (1) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | Yes (1) | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | 0 | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | Yes (1) | ConsolidatedAuditFinclStmtInd |
| School Operating | 0 | SchoolOperatingInd |
| Foreign Office | 0 | ForeignOfficeInd |
| Foreign Activities | 0 | ForeignActivitiesInd |
| More Than5000 K To Org | 0 | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividualsInd |
| Professional Fundraising | 0 | ProfessionalFundraisingInd |
| Fundraising Activities | 0 | FundraisingActivitiesInd |
| Gaming Activities | 0 | GamingActivitiesInd |
| Operate Hospital | 0 | OperateHospitalInd |
| Grants To Organizations | Yes (1) | GrantsToOrganizationsInd |
| Grants To Individuals | Yes (1) | GrantsToIndividualsInd |
| Schedule J Required | Yes (1) | ScheduleJRequiredInd |
| Tax Exempt Bonds | 0 | TaxExemptBondsInd |
| Engaged In Excess Benefit Trans | 0 | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | 0 | PYExcessBenefitTransInd |
| Loan Outstanding | 0 | LoanOutstandingInd |
| Grant To Related Person | 0 | GrantToRelatedPersonInd |
| Business Rln With Org Mem | 0 | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | 0 | BusinessRlnWithFamMemInd |
| Business Rln With35 Ctrl Ent | 0 | BusinessRlnWith35CtrlEntInd |
| Deductible Non Cash Contri | 0 | DeductibleNonCashContriInd |
| Deductible Art Contribution | 0 | DeductibleArtContributionInd |
| Terminate Operations | 0 | TerminateOperationsInd |
| Partial Liquidation | 0 | PartialLiquidationInd |
| Disregarded Entity | 0 | DisregardedEntityInd |
| Related Entity | Yes (1) | RelatedEntityInd |
| Related Organization Ctrl Ent | Yes (1) | RelatedOrganizationCtrlEntInd |
| Transaction With Control Ent | 0 | TransactionWithControlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | 0 | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| IRP Document | 4 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (1) | BackupWthldComplianceInd |
| Employee | 0 | EmployeeCnt |
| Unrelated Bus Incm Over Limit | 0 | UnrelatedBusIncmOverLimitInd |
| Foreign Financial Account | 0 | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | 0 | TaxablePartyNotificationInd |
| Nondeductible Contributions | 0 | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributionsInd |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOfInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | 0 | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | 0 | PayPremiumsPrsnlBnftCntrctInd |
| Indoor Tanning Services | 0 | IndoorTanningServicesInd |
| Subj To Tax Rmnrtn Ex Prcht Pymt | 0 | SubjToTaxRmnrtnExPrchtPymtInd |
| Subject To Excs Tax Net Invst Inc | 0 | SubjectToExcsTaxNetInvstIncInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 8 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 5 | IndependentVotingMemberCnt |
| Family Or Business Rln | 0 | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | 0 | DelegationOfMgmtDutiesInd |
| Change To Org Documents | 0 | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | Yes (1) | MembersOrStockholdersInd |
| Election Of Board Members | Yes (1) | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | 0 | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (1) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (1) | MinutesOfCommitteesInd |
| Officer Mailing Address | 0 | OfficerMailingAddressInd |
| Local Chapters | 0 | LocalChaptersInd |
| Form990 Provided To Gvrn Body | Yes (1) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (1) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (1) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (1) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (1) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (1) | DocumentRetentionPolicyInd |
| Compensation Process CEO | 0 | CompensationProcessCEOInd |
| Compensation Process Other | 0 | CompensationProcessOtherInd |
| Investment In Joint Venture | 0 | InvestmentInJointVentureInd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | NATHAN STADHEIM | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 7015676150 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1000 HIGHWAY 12 | AddressLine1Txt |
| City | HETTINGER | CityNm |
| State Abbreviation | ND | StateAbbreviationCd |
| ZIP | 58639 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (12 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt |
|---|---|---|---|---|---|---|---|
| CODY JORGENSON | |||||||
| CHAIRMAN | 1.00 | Yes (X) | Yes (X) | $50 | $0 | $0 | |
| BONNIE SMITH | |||||||
| VICE CHAIRMAN | 1.00 | Yes (X) | Yes (X) | $10 | $0 | $0 | |
| STEVE HEDSTROM | |||||||
| SECRETARY/TREASURER | 1.00 | Yes (X) | Yes (X) | $40 | $0 | $0 | |
| CONNIE BURWICK | |||||||
| REPRESENTATIVE | 1.00 | Yes (X) | $50 | $0 | $0 | ||
| JOHN JOYCE | |||||||
| REPRESENTATIVE | 1.00 | Yes (X) | $40 | $0 | $0 | ||
| JONATHON EATON | |||||||
| REPRESENTATIVE | 1.00 | Yes (X) | $70 | $0 | $0 | ||
| JENNIFER JOHNSON | |||||||
| REPRESENTATIVE | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| EVE SAFRATOWICH | |||||||
| REPRESENTATIVE | 1.00 | Yes (X) | $20 | $0 | $0 | ||
| LEONARD BJERKLIE | |||||||
| REPRESENTATIVE | 1.00 | Yes (X) | $60 | $0 | $0 | ||
| DR JOSH RANUM | |||||||
| MEDICAL STAFF LIASON | 1.00 | Yes (X) | $0 | $294,248 | $18,142 | 39.00 | |
| MATT SHAHAN | |||||||
| PRESIDENT, CEO | 1.00 | Yes (X) | $0 | $198,503 | $38,673 | 39.00 | |
| NATHAN STADHEIM | |||||||
| CFO | 2.00 | Yes (X) | $0 | $135,601 | $30,347 | 38.00 | |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $340 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $628,352 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $87,162 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 0 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | 0 | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (1) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | 0 | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp
Contractor Name ContractorName
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | WEST RIVER HEALTH SERVICES | BusinessNameLine1Txt |
Contractor Address ContractorAddress
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1000 HIGHWAY 12 | AddressLine1Txt |
| City | HETTINGER | CityNm |
| State Abbreviation | ND | StateAbbreviationCd |
| ZIP | 58639 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Services | STAFFING & MANAGEMENT SERVICES | ServicesDesc |
| Compensation | $115,940 | CompensationAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 1 | CntrctRcvdGreaterThan100KCnt |
| Fundraising | $8,212 | FundraisingAmt |
| All Other Contributions | $258,132 | AllOtherContributionsAmt |
| Total Contributions | $266,344 | TotalContributionsAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $167,733 | TotalRevenueColumnAmt |
| Exclusion | $167,733 | ExclusionAmt |
Gross Rents GrossRentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $60,900 | RealAmt |
Less Rental Expenses LessRentalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $10,576 | RealAmt |
Rental Income Or Loss RentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $50,324 | RealAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $50,324 | TotalRevenueColumnAmt |
| Exclusion | $50,324 | ExclusionAmt |
Gross Amount Sales Assets GrossAmountSalesAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $903,179 | SecuritiesAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $675,376 | SecuritiesAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $227,803 | SecuritiesAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $227,803 | TotalRevenueColumnAmt |
| Exclusion | $227,803 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Fundraising Gross Income | $0 | FundraisingGrossIncomeAmt |
| Contri Rpt Fundraising Event | $8,212 | ContriRptFundraisingEventAmt |
| Fundraising Direct Expenses | $3,748 | FundraisingDirectExpensesAmt |
Net Incm From Fundraising Evt NetIncmFromFundraisingEvtGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -$3,748 | TotalRevenueColumnAmt |
| Exclusion | -$3,748 | ExclusionAmt |
Other Revenue Misc OtherRevenueMiscGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | MISCELLANEOUS REVENUE | Desc |
| Business | 900099 | BusinessCd |
| Total Revenue Column | $1,631 | TotalRevenueColumnAmt |
| Exclusion | $1,631 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $1,631 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $710,087 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $0 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $443,743 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part IX | Yes (X) | InfoInScheduleOPartIXInd |
Grants To Domestic Orgs GrantsToDomesticOrgsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $138,614 | TotalAmt |
| Program Services | $138,614 | ProgramServicesAmt |
Grants To Domestic Individuals GrantsToDomesticIndividualsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $15,400 | TotalAmt |
| Program Services | $15,400 | ProgramServicesAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $430 | TotalAmt |
| Management And General | $430 | ManagementAndGeneralAmt |
Fees For Services Management FeesForServicesManagementGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $6,720 | TotalAmt |
| Management And General | $6,720 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $29,121 | TotalAmt |
| Management And General | $29,121 | ManagementAndGeneralAmt |
Fees For Srvc Invst Mgmnt Fees FeesForSrvcInvstMgmntFeesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $47,645 | TotalAmt |
| Fundraising | $47,645 | FundraisingAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $91,916 | TotalAmt |
| Management And General | $1,676 | ManagementAndGeneralAmt |
| Fundraising | $90,240 | FundraisingAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $26,555 | TotalAmt |
| Fundraising | $26,555 | FundraisingAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $7,493 | TotalAmt |
| Management And General | $2,754 | ManagementAndGeneralAmt |
| Fundraising | $4,739 | FundraisingAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,088 | TotalAmt |
| Management And General | $2,965 | ManagementAndGeneralAmt |
| Fundraising | $123 | FundraisingAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $800 | TotalAmt |
| Management And General | $800 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,813 | TotalAmt |
| Management And General | $2,813 | ManagementAndGeneralAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $370,595 | TotalAmt |
| Program Services | $154,014 | ProgramServicesAmt |
| Management And General | $47,279 | ManagementAndGeneralAmt |
| Fundraising | $169,302 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $210,791 | BOYAmt |
| EOY | $322,708 | EOYAmt |
Pledges And Grants Receivable PledgesAndGrantsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $60,496 | BOYAmt |
| EOY | $31,752 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $446 | BOYAmt |
| EOY | $569 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $659,612 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $20,552 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $639,860 | BOYAmt |
| EOY | $639,060 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,851,593 | BOYAmt |
| EOY | $4,915,198 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $156,647 | BOYAmt |
| EOY | $162,031 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $5,919,833 | BOYAmt |
| EOY | $6,071,318 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $220 | BOYAmt |
| EOY | $391 | EOYAmt |
Deferred Revenue DeferredRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $15,617 | BOYAmt |
| EOY | $14,833 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $92,317 | BOYAmt |
| EOY | $104,102 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $108,154 | BOYAmt |
| EOY | $119,326 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows FASB117 | Yes (X) | OrganizationFollowsFASB117Ind |
No Donor Restriction Net Assets NoDonorRestrictionNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,607,275 | BOYAmt |
| EOY | $4,604,034 | EOYAmt |
Donor Restriction Net Assets DonorRestrictionNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,204,404 | BOYAmt |
| EOY | $1,347,958 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $5,811,679 | BOYAmt |
| EOY | $5,951,992 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $5,919,833 | BOYAmt |
| EOY | $6,071,318 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | $339,492 | ReconcilationRevenueExpnssAmt |
| Net Unrlzd Gains Losses Invst | -$199,179 | NetUnrlzdGainsLossesInvstAmt |
| Other Changes In Net Assets | $0 | OtherChangesInNetAssetsAmt |
| Info In Schedule O Part XII | Yes (X) | InfoInScheduleOPartXIIInd |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | 0 | AccountantCompileOrReviewInd |
| FS Audited | Yes (1) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Consolidated Basis Fincl Stmt | Yes (X) | ConsolidatedBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | Yes (1) | AuditCommitteeInd |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequiredInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Supporting Organization509a3 | Yes (X) | SupportingOrganization509a3Ind |
| Supporting Org Type3 Func Int | Yes (X) | SupportingOrgType3FuncIntInd |
| Supported Organizations | 2 | SupportedOrganizationsCnt |
Supported Org Information SupportedOrgInformationGrp (2 entries)
| EINEIN | Organization TypeOrganizationTypeCd | Governing Document ListedGoverningDocumentListedInd | SupportSupportAmt | Other SupportOtherSupportAmt |
|---|---|---|---|---|
| WEST RIVER HEALTH SERVICES | ||||
| 450340688 | 3 | Yes (1) | $126,390 | $0 |
| WESTERN HORIZONS LIVING CENTERS | ||||
| 260794602 | 10 | 0 | $3,924 | $0 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Supported Organizations Total | 2 | SupportedOrganizationsTotalCnt |
| Support Sum | $130,314 | SupportSumAmt |
| Other Support Sum | $0 | OtherSupportSumAmt |
Form990 Sch A Supporting Org Form990SchASupportingOrgGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Listed By Name Governing Doc | 0 | ListedByNameGoverningDocInd |
| Suprt Org No IRS Determination | 0 | SuprtOrgNoIRSDeterminationInd |
| Supported Org Section C456 | 0 | SupportedOrgSectionC456Ind |
| Supported Org Not Organized US | 0 | SupportedOrgNotOrganizedUSInd |
| Organization Change Suprt Org | 0 | OrganizationChangeSuprtOrgInd |
| Support Non Supported Org | 0 | SupportNonSupportedOrgInd |
| Payment Substantial Contribtr | 0 | PaymentSubstantialContribtrInd |
| Loan Disqualified Person | 0 | LoanDisqualifiedPersonInd |
| Controlled Disqualified Prsn | 0 | ControlledDisqualifiedPrsnInd |
| Disqualified Prsn Controll Int | 0 | DisqualifiedPrsnControllIntInd |
| Disqualified Prsn Ownr Int | 0 | DisqualifiedPrsnOwnrIntInd |
| Excess Business Holdings Rules | 0 | ExcessBusinessHoldingsRulesInd |
| Contribution Controller | 0 | ContributionControllerInd |
| Contribution Family | 0 | ContributionFamilyInd |
| Contribution35 Controlled | 0 | Contribution35ControlledInd |
Form990 Sch A Type3 Sprt Org All Form990SchAType3SprtOrgAllGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Timely Provided Documents | Yes (1) | TimelyProvidedDocumentsInd |
| Officers Close Relationship | Yes (1) | OfficersCloseRelationshipInd |
| Supported Org Voice Investment | 0 | SupportedOrgVoiceInvestmentInd |
Form990 Sch A Type3 Func Int Form990SchAType3FuncIntGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Parent Supported Org | Yes (X) | ParentSupportedOrgInd |
| Appoint Elect Majority Officer | Yes (1) | AppointElectMajorityOfficerInd |
| Exercise Direction Policies | Yes (1) | ExerciseDirectionPoliciesInd |
Form990 Schedule A Part VI Form990ScheduleAPartVIGrp (3 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART IV SECTION A LINE 1 | WEST RIVER HEALTH SERVICES IS LISTED BY NAME IN THE ORGANIZATION'S GOVERNING DOCUMENTS. WESTERN HORIZONS LIVING CENTER IS NOT LISTED BY NAME IN THE GOVERNING DOCUMENTS. HOWEVER, THE ORGANIZATION PROVIDES SUPPORT TO ALL OF THE ORGANIZATIONS FOR WHICH IT IS NAMED AS THE MEMBER IN THE SUPPORTED ORGANIZATIONS' GOVERNING DOCUMENTS. IN THIS CASE, BOTH WEST RIVER HEALTH SERVICES AND WESTERN HOIZONS LIVING CENTER LIST THE ORGANIZATION AS THEIR SOLE MEMBER IN EACH OF THEIR RESPECTIVE GOVERNING DOCUMENTS. |
| PART IV SECTION E LINE 3A | THE ORGANIZATION IS RESPONSIBLE FOR ELECTING THE DIRECTORS FOR EACH OF ITS SUPPORTED ORGANIZATIONS. |
| PART IV SECTION E LINE 3B | THE ORGANIZATION APPROVES AND MAKES AMENDMENTS TO THE SUPPORTED ORGANIZATIONS' GOVERNING DOCUMENT AND POLICIES. |
Schedule B IRS990ScheduleB
Contributor Information ContributorInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor | RESTRICTED | ContributorNum |
Contributor Business Name ContributorBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor US Address ContributorUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Contributions | RESTRICTED | TotalContributionsAmt |
Schedule D IRS990ScheduleD
CY Endwmt Fund CYEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $989,081 | BeginningYearBalanceAmt |
| Contributions | $206,762 | ContributionsAmt |
| Investment Earnings Or Losses | $40,219 | InvestmentEarningsOrLossesAmt |
| Grants Or Scholarships | $105,243 | GrantsOrScholarshipsAmt |
| Administrative Expenses | $8,087 | AdministrativeExpensesAmt |
| End Year Balance | $1,122,732 | EndYearBalanceAmt |
CY Minus1 Yr Endwmt Fund CYMinus1YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $618,303 | BeginningYearBalanceAmt |
| Contributions | $204,280 | ContributionsAmt |
| Investment Earnings Or Losses | $184,796 | InvestmentEarningsOrLossesAmt |
| Grants Or Scholarships | $11,900 | GrantsOrScholarshipsAmt |
| Administrative Expenses | $6,398 | AdministrativeExpensesAmt |
| End Year Balance | $989,081 | EndYearBalanceAmt |
CY Minus2 Yr Endwmt Fund CYMinus2YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $535,772 | BeginningYearBalanceAmt |
| Contributions | $124,855 | ContributionsAmt |
| Investment Earnings Or Losses | -$27,566 | InvestmentEarningsOrLossesAmt |
| Grants Or Scholarships | $10,210 | GrantsOrScholarshipsAmt |
| Administrative Expenses | $4,548 | AdministrativeExpensesAmt |
| End Year Balance | $618,303 | EndYearBalanceAmt |
CY Minus3 Yr Endwmt Fund CYMinus3YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $405,570 | BeginningYearBalanceAmt |
| Contributions | $123,661 | ContributionsAmt |
| Investment Earnings Or Losses | $23,932 | InvestmentEarningsOrLossesAmt |
| Grants Or Scholarships | $14,300 | GrantsOrScholarshipsAmt |
| Administrative Expenses | $3,091 | AdministrativeExpensesAmt |
| End Year Balance | $535,772 | EndYearBalanceAmt |
CY Minus4 Yr Endwmt Fund CYMinus4YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $345,787 | BeginningYearBalanceAmt |
| Contributions | $50,621 | ContributionsAmt |
| Investment Earnings Or Losses | $25,554 | InvestmentEarningsOrLossesAmt |
| Grants Or Scholarships | $14,250 | GrantsOrScholarshipsAmt |
| Administrative Expenses | $2,142 | AdministrativeExpensesAmt |
| End Year Balance | $405,570 | EndYearBalanceAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Prmnnt Endowment Balance EOY | 0.87900 | PrmnntEndowmentBalanceEOYPct |
| Term Endowment Balance EOY | 0.12100 | TermEndowmentBalanceEOYPct |
| Endowments Held Unrelated Org | 0 | EndowmentsHeldUnrelatedOrgInd |
| Endowments Held Related Org | 0 | EndowmentsHeldRelatedOrgInd |
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Investment Cost Or Other Basis | $633,264 | InvestmentCostOrOtherBasisAmt |
| Book Value | $633,264 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $26,348 | OtherCostOrOtherBasisAmt |
| Depreciation | $20,552 | DepreciationAmt |
| Book Value | $5,796 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $639,060 | TotalBookValueLandBuildingsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp (3 entries)
| DescDesc | AmtAmt |
|---|---|
| DUE TO RELATED PARTY | $25,281 |
| LIFE INSURANCE PAYABLE | $76,382 |
| ACCRUED PROPERTY TAX | $2,439 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $104,102 | TotalLiabilityAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
| Total Rev Etc Audited Fincl Stmt | $477,587 | TotalRevEtcAuditedFinclStmtAmt |
| Net Unrealized Gains Invst | -$199,179 | NetUnrealizedGainsInvstAmt |
| Revenue Not Reported | -$199,179 | RevenueNotReportedAmt |
| Revenue Subtotal | $676,766 | RevenueSubtotalAmt |
| Investment Expenses Not Incld | $47,645 | InvestmentExpensesNotIncldAmt |
| Other Revenues Not Included | -$14,324 | OtherRevenuesNotIncludedAmt |
| Revenue Not Reported Fincl Stmt | $33,321 | RevenueNotReportedFinclStmtAmt |
| Total Revenue Per Form990 | $710,087 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $337,274 | TotExpnsEtcAuditedFinclStmtAmt |
| Other Expenses Included | $14,324 | OtherExpensesIncludedAmt |
| Expenses Not Reported | $14,324 | ExpensesNotReportedAmt |
| Expenses Subtotal | $322,950 | ExpensesSubtotalAmt |
| Investment Expenses Not Incld2 | $47,645 | InvestmentExpensesNotIncld2Amt |
| Expenses Not Rpt Fincl Stmt | $47,645 | ExpensesNotRptFinclStmtAmt |
| Total Expenses Per Form990 | $370,595 | TotalExpensesPerForm990Amt |
Supplemental Information Detail SupplementalInformationDetail (4 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART V, LINE 4: | THE ENDOWMENT FUND WILL BE USED AS A PERMANENT FUNDING SOURCE FOR WRHS AND WHLC TO CARRY OUT THEIR VISION OF ENSURING QUALITY HEALTH AND LONG-TERM CARE SERVICES TO THE CITIZENS OF THE REGION. SPECIFIC GOALS FOR THE ENDOWMENT FUND ARE AS FOLLOWS: TO PROVIDE FUNDS FOR EQUIPMENT; TO ASSIST WITH HEALTH RELATED PROGRAMS AND SERVICES; TO SUPPORT COMMUNITY WELLNESS EDUCATION; TO PROVIDE SCHOLARSHIPS AND LOANS FOR HEALTHCARE PROFESSIONALS; AND TO AID HOSPITAL, CLINICS AND LIVING CENTERS IN THEIR CORPORATE MISSIONS. |
| PART X, LINE 2: | THE FOUNDATION IS EXEMPT FROM FEDERAL AND STATE INCOME TAXES UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE AND IS DETERMINED NOT TO BE A PRIVATE FOUNDATION UNDER SECTION 170(B)(1)(A)(II) OF THE CODE. THE FOUNDATION IS NOT LIABLE FOR INCOME TAXES IF IT OPERATES WITHIN THE CONFINES OF ITS EXEMPT STATUS. HOWEVER, IT MAY BE RESPONSIBLE FOR TAXES ON UNRELATED BUSINESS ACTIVITIES. IN THE EVENT OF AN EXAMINATION OF THE INCOME TAX RETURNS, THE TAX LIABILITY OF THE FOUNDATION COULD BE CHANGED IF TAXING AUTHORITIES MAKE ADJUSTMENTS TO THE TAX-EXEMPT PURPOSE OF THE ENTITIES OR IF TAXING AUTHORITIES DETERMINE ACTIVITIES ARE SUBJECT TO UNRELATED BUSINESS INCOME. AS OF MARCH 31, 2022, THE FOUNDATION HAD NO UNCERTAIN TAX POSITIONS THAT QUALIFIED FOR EITHER RECOGNITION OR DISCLOSURE IN THE FINANCIAL STATEMENTS. THE INCOME TAX FILINGS ARE SUBJECT TO AUDIT BY VARIOUS TAXING AUTHORITIES. THE FOUNDATION IS NO LONGER SUBJECT TO FEDERAL AND STATE INCOME TAX EXAMINATIONS BY TAXING AUTHORITIES FOR FISCAL YEARS BEFORE 2019. MANAGEMENT CONTINUALLY EVALUATES EXPIRING STATUTES OF LIMITATION, AUDITS, PROPOSED SETTLEMENTS, CHANGES IN TAX LAW, AND NEW AUTHORITATIVE RULINGS. MANAGEMENT BELIEVES ESTIMATES ARE APPROPRIATE BASED ON CURRENT FACTS AND CIRCUMSTANCES. INTEREST AND PENALTIES ASSESSED BY INCOME TAXING AUTHORITIES, IF ANY, ARE INCLUDED IN INTEREST EXPENSE. |
| PART XI, LINE 4B - OTHER ADJUSTMENTS: | RENTAL EXPENSES -10,576. DIRECT FUNDRAISING EXPENSES -3,748. |
| PART XII, LINE 2D - OTHER ADJUSTMENTS: | RENTAL EXPENSES 10,576. DIRECT FUNDRAISING EXPENSES 3,748. |
Schedule I IRS990ScheduleI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Grant Records Maintained | Yes (1) | GrantRecordsMaintainedInd |
Recipient Table RecipientTable
Recipient Business Name RecipientBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | WEST RIVER HEALTH SERVICES | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1000 HIGHWAY 12 | AddressLine1Txt |
| City | HETTINGER | CityNm |
| State Abbreviation | ND | StateAbbreviationCd |
| ZIP | 58639 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Recipient EIN | 450340688 | RecipientEIN |
| IRC Section | 501(C)(3) | IRCSectionDesc |
| Cash Grant | $126,390 | CashGrantAmt |
| Non Cash Assistance | $0 | NonCashAssistanceAmt |
| Purpose Of Grant | SUPPORT | PurposeOfGrantTxt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total501c3 Org | 1 | Total501c3OrgCnt |
| Total Other Org | 0 | TotalOtherOrgCnt |
Grants Other Asst To Indiv In US GrantsOtherAsstToIndivInUSGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Grant Type | MEDICAL SCHOLARSHIPS | GrantTypeTxt |
| Recipient | 15 | RecipientCnt |
| Cash Grant | $15,400 | CashGrantAmt |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART I, LINE 2: | FormAndLineReferenceDesc |
| Explanation | THE GRANTS FROM WEST RIVER HEALTH SERVICES FOUNDATION ARE BEING MADE TO WEST RIVER HEALTH SERVICES AND WESTERN HORIZONS LIVING CENTER, RELATED ORGANIZATIONS. THE CEO, CFO, AND BOARD CHAIR OF WEST RIVER HEALTH SERVICES FOUNDATION MONITOR THE USE OF THE GRANT FUNDS THROUGH THEIR POSITIONS AS CEO, CFO, AND A BOARD MEMBER AT WEST RIVER HEALTH SERVICES AND WESTERN HORIZONS LIVING CENTER. | ExplanationTxt |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Severance Payment | 0 | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | 0 | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | 0 | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | 0 | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | 0 | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | 0 | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | 0 | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | 0 | AnyNonFixedPaymentsInd |
| Initial Contract Exception | 0 | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (3 entries)
| TitleTitleTxt | Base Compensation Filing OrgBaseCompensationFilingOrgAmt | Compensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmt | Bonus Filing OrganizationBonusFilingOrganizationAmount | Bonus Related OrganizationsBonusRelatedOrganizationsAmt | Other Compensation Filing OrgOtherCompensationFilingOrgAmt | Other Compensation Rltd OrgsOtherCompensationRltdOrgsAmt | Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt | Deferred Comp Rltd OrgsDeferredCompRltdOrgsAmt | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt | Nontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmt | Total Compensation Filing OrgTotalCompensationFilingOrgAmt | Total Compensation Rltd OrgsTotalCompensationRltdOrgsAmt | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmt | Comp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| DR JOSH RANUM | ||||||||||||||
| MEDICAL STAFF LIASON | $0 | $294,248 | $0 | $0 | $0 | $0 | $0 | $8,700 | $0 | $9,442 | $0 | $312,390 | $0 | $0 |
| MATT SHAHAN | ||||||||||||||
| PRESIDENT, CEO | $0 | $198,503 | $0 | $0 | $0 | $0 | $0 | $6,620 | $0 | $32,053 | $0 | $237,176 | $0 | $0 |
| NATHAN STADHEIM | ||||||||||||||
| CFO | $0 | $135,601 | $0 | $0 | $0 | $0 | $0 | $4,528 | $0 | $25,819 | $0 | $165,948 | $0 | $0 |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART I, LINE 3 | FormAndLineReferenceDesc |
| Explanation | THE ORGANIZATION'S CEO IS COMPENSATED BY WEST RIVER HEALTH SERVICES (A RELATED PARTY). THE WEST RIVER HEALTH SERVICES BOARD OF DIRECTORS DETERMINES THE CEO'S COMPENSATION VIA COMPENSATION COMMITTEE, COMPENSATION SURVEY OR STUDY, AND APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE. | ExplanationTxt |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (9 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PART VI, SECTION A, LINE 1A | THE EXECUTIVE COMMITTEE CAN ACT FOR AND ON BEHALF OF THE FULL BOARD. IT IS COMPRISED OF THE CEO, FUND DEVELOPMENT DIRECTOR, CHAIR, VICE CHAIR, SECRETARY/TREASURER, PAST CHAIR, MEDICAL STAFF REPRESENTATIVE, ONE MEMBER OF THE HOSPITAL BOARD, AND ONE MEMBER OF THE WHLC BOARD. |
| FORM 990, PART VI, SECTION A, LINE 6 | THERE IS ONLY ONE CLASS OF MEMBERS. MEMBERS ARE ANY INDIVIDUALS THAT HAVE CONTRIBUTED THE SUM OF ONE DOLLAR AND ARE RESIDENTS OF THE PRIMARY CARE SERVICE AREA OF THE FOUNDATION. |
| FORM 990, PART VI, SECTION A, LINE 7A | EACH MEMBER HAS ONE VOTE AT THE ANNUAL MEETING. |
| FORM 990, PART VI, SECTION B, LINE 11B | THE CEO AND CFO WILL REVIEW THE FORM 990 PRIOR TO THE COMPLETED FORM 990 BEING DISTRIBUTED ELECTRONICALLY TO THE BOARD MEMBERS FOR THEIR REVIEW AND COMMENTS. THE FORM 990 IS ALSO REVIEWED AND DISCUSSED AT A BOARD MEETING. |
| FORM 990, PART VI, SECTION B, LINE 12C | ALL BOARD MEMBERS ARE REQUIRED TO ANNUALLY DISCLOSE ANY POTENTIAL CONFLICTS. POTENTIAL CONFLCITS 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 15 | COMPENSATION PAID TO THE CEO & CFO IS PAID AND DETERMINED BY A RELATED ORGANIZATION, WEST RIVER HEALTH SERVICES (WRHS). THE COMPENSATION PROCEDURES USED BY WRHS ARE AS FOLLOWS: CEO: EACH BOARD AND MEDICAL STAFF MEMBER ANNUALLY COMPLETES AN EVALUATION FORM ON THE CEO'S PERFORMANCE. THE CHAIRMAN OF THE EXECUTIVE COMMITTEE TABULATES THE RESULTS AND REVIEWS WITH THE MEMBERS OF THE EXECUTIVE COMMITTEE. RESULTS ARE PRESENTED TO THE FULL BOARD OF DIRECTORS WHO HAVE FINAL AUTHORITY IN DETERMINING COMPENSATION. COMPARABILITY DATA FROM THE STATE HOSPITAL ASSOCIATION, AS WELL AS OTHER COMPARATIVE INDUSTRY INFORMATION, IS USED IN DETERMINING COMPENSATION. CFO: THE CEO REVIEWS THE CFO PERFORMANCE AND USES COMPARABILITY DATA IN DETERMINING COMPENSATION. |
| FORM 990, PART VI, SECTION C, LINE 19 | THE GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE AVAILABLE TO THE PUBLIC UPON REQUEST. |
| FORM 990, PART IX, LINE 11G | OTHER PROFESSIONAL FEES: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 1,676. FUNDRAISING EXPENSES 90,240. TOTAL EXPENSES 91,916. |
| PART XII, LINE 2C | THE BOARD OF DIRECTORS IS RESPONSIBLE FOR THE OVERSIGHT OF THE AUDIT. THIS PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR. |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (2 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Exempt Code SectionExemptCodeSectionTxt | Public Charity StatusPublicCharityStatusTxt | Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt | Controlled OrganizationControlledOrganizationInd |
|---|---|---|---|---|---|---|---|---|---|---|
| WEST RIVER HEALTH SERVICES | ||||||||||
| 1000 HIGHWAY 12 | HETTINGER | ND | 58639 | 450340688 | HOSPITAL | ND | 501(C)(3) | LINE 3 | WEST RIVER HEALTH SERVICES FOUNDATION | Yes (1) |
| WESTERN HORIZONS LIVING CENTERS | ||||||||||
| 1104 HIGHWAY 12 | HETTINGER | ND | 58639 | 260794602 | LONG-TERM CARE/ASSISTED LIVING SERVICES | ND | 501(C)(3) | LINE 10 | WEST RIVER HEALTH SERVICES FOUNDATION | Yes (1) |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | 0 | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | Yes (1) | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | 0 | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | Yes (1) | LoansOrGuaranteesFromOthOrgInd |
| Div Related Organization | 0 | DivRelatedOrganizationInd |
| Asset Sale To Other Org | 0 | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | 0 | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | 0 | AssetExchangeInd |
| Rental Of Facilities To Oth Org | 0 | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | 0 | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | 0 | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | 0 | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | 0 | SharingOfFacilitiesInd |
| Paid Employees Sharing | 0 | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | Yes (1) | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | 0 | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | 0 | TransferToOtherOrgInd |
| Transfer From Other Org | 0 | TransferFromOtherOrgInd |
Transactions Related Org TransactionsRelatedOrgGrp (4 entries)
| Transaction TypeTransactionTypeTxt | InvolvedInvolvedAmt | Method Of Amount DeterminationMethodOfAmountDeterminationTxt |
|---|---|---|
| WESTERN HORIZONS LIVING CENTERS | ||
| B | $3,924 | CASH PAID |
| WEST RIVER HEALTH SERVICES | ||
| B | $126,390 | CASH PAID |
| WEST RIVER HEALTH SERVICES | ||
| P | $115,041 | CASH PAID |
| WEST RIVER HEALTH SERVICES | ||
| E | $25,281 | CASH PAID |