2023-11-13T15:51:52-06:00 2022-12-31 450250958 Eide Bailly LLP 1730 Burnt Boat Loop Ste 100 Bismarck ND 585030886 990 2022-01-01 450458242 Southwest Healthcare Services SOUT 7015235555 802 2nd St NW Bowman ND 58623 Dennis Goebel CEO 7015235555 2023-11-13 1 Dennis Goebel 999009999 1 Lisa Chaffee CPA P00193453 7012551091 2023-11-13 2 AAL1 IAL1 2022 2023-04-26 12:10:37Z Dennis Goebel 802 2nd St NW Bowman ND 58623 14927583 0 X www.swhealthcare.net X 2000 ND Southwest Healthcare Services is organized to provide quality health care services. 8 7 164 150 0 0 3896205 889451 13031712 13964863 80285 33207 120777 3951 17128979 14891472 0 0 0 0 7645229 7372364 0 0 4208 7774022 8719382 15419251 16091746 1709728 -1200274 36154492 33427348 28536555 27432478 7617937 5994870 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 1 13576619 13965481 Southwest Healthcare Services (Southwest) consists of a 35-bed acute care hospital which includes a long-term Swingbed program for our nursing home residents, 12-unit apartment complex, 12-unit assisted living facility, visiting nurse service agency, clinic, and ambulance service located in Bowman, North Dakota.Southwest Healthcare Services is organized to provide quality health care services for individuals in the surrounding community. Southwest Healthcare Services operates an acute care hospital, long-term Swingbed, rural health clinic, ambulance service, outpatient therapy services and elderly living facilities. Southwest operates a full-time emergency room and provides emergency care regardless of ability to pay. Southwest also provides clinical services needed to operate the emergency center and provides on-site emergency medical, rescue and medical transportation services.Southwest Healthcare Services 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. Southwest Healthcare Services is 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, Southwest provides care to these patients who meet certain criteria under its charity care policy without charge or at amounts less than its established rates. Because Southwest does 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, 2022 was $69,719.Southwest Healthcare Services reaches out to people and communities throughout southwestern North Dakota, northwestern South Dakota and eastern Montana through specific health events and health education, for example: reduced rate sports physicals for students, health fairs, and skin cancer screenings. However, due to COVID-19, we were unable to do as much community outreach compared to prior years. We were unable to provide a health fair in 2022 just like the prior couple of years. Fortunately, our ambulance and sports medicine were able to volunteer at sporting events and other community events in 2022. 13576619 1 1 0 0 0 0 0 0 1 1 1 0 0 1 1 1 1 0 0 0 0 0 0 0 1 0 1 1 0 0 1 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 1 41 0 1 164 1 0 0 0 0 0 0 0 0 0 0 0 0 X 8 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 Tim Adams Physician 40.00 X 365326 0 14967 Roy Cordy Physician 40.00 X 354371 0 8211 Dennis Goebel CEO 40.00 X 199249 0 10680 Christine Peterson NP Trustee 40.00 X 181215 0 0 Patricia Gilbert Physicians Assistant 40.00 X 145262 0 0 Jessica Erickson Pharmacist 40.00 X 119368 0 7200 Kurt Datz Physician 10.00 X 123334 0 0 Amanda Loughman CFO 40.00 X 104532 0 16387 Duane Bowman President (Jan-Jun) 1.00 X X 0 0 0 Teran Doerr Vice President (Jan-Jun)/President (Jul-Dec) 1.00 X X 0 0 0 Andrew Weiss Secretary Jan- Jun)/Vice President (Jul-Dec) 1.00 X X 0 0 0 Jordan Anderson Trustee Jan- Jun)/Secretary (Jul-Dec) 1.00 X X 0 0 0 Chanell Walby Trustee 1.00 X 0 0 0 Tami Gilbert Trustee (Jan-Jun) 1.00 X 0 0 0 Laurie Braaten Trustee 1.00 X 0 0 0 Wendy Stuber Trustee 1.00 X 0 0 0 Connie Gaebe Trustee 1.00 X 0 0 0 1592657 0 57445 11 0 1 0 E R Gard Corp PO Box A Bowman ND 58623 Physician Coverage 152126 1 39582 373121 476748 22447 889451 Patient & Resident Service Revenu 621110 13029778 13029778 Pharmacy Revenue 456110 687080 687080 Supporting Revenue 900099 248005 248005 13964863 19800 19800 13407 0 13407 13407 13407 39444 39582 36111 3333 3333 618 0 618 618 14891472 13965481 0 36540 X 526463 184647 341816 50872 38154 12718 5635364 5021292 614072 710943 496909 214034 448722 380286 68436 6130 6130 84255 84255 3399921 2988655 411266 67198 67198 296367 224645 71722 300781 300781 367541 333049 34492 89992 73304 16688 2418 2418 451620 451620 2421980 2284493 137487 102702 102702 Medical Supplies 915090 915090 Dietary Food and Supple 143464 143464 Dues, Licensing & Subsc 63789 39085 24704 6134 1926 4208 16091746 13576619 2510919 4208 3381168 466132 3535 1777063 2110795 309029 352234 103763 187927 48881306 23673964 27423429 25207342 2143941 2510718 1016099 2588665 36154492 33427348 934296 1337013 627272 0 878 934 26810109 25789205 164000 305326 28536555 27432478 X 6481508 5121673 1136429 873197 7617937 5994870 36154492 33427348 X -1200274 -181720 -241073 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 1 16087 6936 4208 18815 1 X 127112 -24887 102225 127112 14308 14308 127112 127112 10556 10556 127112 127112 13595 13595 127112 127112 23230 23230 127112 0.00000 1.00000 0.00000 1 0 75488 75488 41228382 17669252 23559130 7545439 6004712 1540727 31997 31997 25207342 Other Assets 7766 Receiveable from Sunrise Foudation 768788 Estimated Third-Party Payor Settlements 1515000 Right of Use Asset 297111 2588665 Right of Use Liability 305326 305326 X 14478135 -181720 -238345 -420065 14898200 -6728 -6728 14891472 16101202 13664 13664 16087538 4208 4208 16091746 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 $934 and $878 in December 31, 2022 and 2021. Part V, Line 4: Endowments held and administered by Southwest Healthcare Services: The principal of $127,112 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, 2022, funds with original gift values of $127,112, fair values of $102,225, and deficiencies of $24,887 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 -238,345. Part XI, Line 4b - Other Adjustments: Auxiliary Revenue 6,936. Fundraising Expenses reported in Revenue on Form 990 -13,664. Part XII, Line 2d - Other Adjustments: Fundraising Expenses reported in Revenue on Form 990 13,664. Part XII, Line 4b - Other Adjustments: Auxiliary Expenses 4,208. Celebrity Waiter 79026 39582 39444 24247 800 5247 3000 2817 79026 39582 39444 24247 800 5247 3000 2817 36111 3333 1 1 X 1 X 1 X 1 1 1 0 1 1 79000 79000 0.00490 308360 139419 168941 0.01050 387360 139419 247941 0.01540 20073 3575 16498 0.00100 3630005 2132280 1497725 0.09310 3650078 2135855 1514223 0.09410 4037438 2275274 1762164 0.10950 3 100 24122 6050 18072 0.00110 3 100 24122 6050 18072 0.00110 1 358705 71741 5394405 5407342 -12937 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 in the 2022 CHNA were: Availability of mental health service, attracting and retaining young families, not enough healthcare staff in general, depression and anxiety (all ages). The needs identified were similar to the needs identified in the prior CHNA from 2019: ability to retain primary care providers, attracting and retaining young families, and availability of mental health services, and depression and anxiety.Southwest Healthcare Services plans on addressing all top identified needs from our 2022 CHNA as outlined in our implementation plan. Note that we grouped availability of mental health services and depression/anxiety together in our implementation plan.In late 2022, we started researching resources for behavioral health and did receive some educational demos. Speakers from the company we plan on engaging with in 2023 came to present at the Board meeting, Department Leader meeting, and the Rotary group's meeting to spread awareness of what their program will be able to offer.In 2022, we were able to fill vacant positions with local residents for a Respiratory Therapist, a Paramedic, an EMR, several Dietary Aides and Dietary Cooks, several CNAs, a Human Resource Director, a couple Housekeeping Aides, and an Activities Aide. We also filled several additional vacant positions, but those employees have since left and the positions have returned vacant. We relocated several new families to the community with our career opportunities. Our Pharmacy Tech was originally from the area but has returned after many years of being away from the state. We relocated a young couple from Maine to work as a Radiology Tech and Lab Tech. We also relocated an Occupational Therapist and reopened the service line in August 2022. We relocated another family to the Bowman area with the opening of the Maintenance-in-Director position. Unfortunately, we were unable to recruit any permanent RN staff and that is where our critical shortage remains. 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 12 and 13 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 5,200 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 2022 of 1.8% in Bowman County, 2.4% in Slope County and 1.7% in Harding County and a median income in 2021 of $69,437 for our service area. In 2022, approximately 11.8% 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 0 0 0 0 0 0 0 0 0 Tim Adams Physician 365326 0 0 0 0 0 0 0 19767 0 385093 0 0 0 Roy Cordy Physician 354371 0 0 0 0 0 0 0 13611 0 367982 0 0 0 Dennis Goebel CEO 199249 0 0 0 0 0 0 0 17880 0 217129 0 0 0 Christine Peterson NP Trustee 181215 0 0 0 0 0 0 0 7200 0 188415 0 0 0 Patricia Gilbert Physicians Assistant 145262 0 0 0 0 0 0 0 7200 0 152462 0 0 0 Jason Anderson Jason is the brother of Board Member Jordan Anderson 50872 Compensation 0 Form 990, Part III, line 2 We began offering Wound Care after hiring a new Occupational Therapist in August of 2022 who became certified in Wound Care. Form 990, Part III, line 3 As of January 1, 2022, we no longer had a Skilled Nursing Facility. Instead, we were able to expand our bed count from 23 to 35 through the FCHIP program. As a result, our previous Nursing Home residents were able to transition to non-skilled Swingbed and still receive the same care by the same staff they were familiar with. We feel that a nursing home in our community is essential and we want to continue to provide this service. 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 initially by the CEO, CFO, and Accountant. The return is then emailed to the Board of Trustees for review and approval prior to being filed with the IRS. 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 A review of current salary surveys for CEOs provided by state associations is reviewed and a performance evaluation is completed by the Board of Directors. A fair compensation is set within the salary survey ranges supplied and as determined by the evaluation review by the Board of Directors. For the CFO, compensation is based on a performance evaluation as well as a review of current market rates through salary surveys for comparable sized facilities. The CEO completes the performance evaluation which is reviewed by Human Resources and if there is a need for a market rate adjustment, this is reviewed at the board level with discussion and data and then approved at that time. These processes take place on an annual basis and are documented in the board minutes. 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 Repairs, Maintenance and Service Contracts and Fees: Program service expenses 429,474. Management and general expenses 107,982. Fundraising expenses 0. Total expenses 537,456. Purchased services & recruitment: Program service expenses 235,521. Management and general expenses 84,501. Fundraising expenses 0. Total expenses 320,022. Professional Fees & Consulting: Program service expenses 2,323,660. Management and general expenses 218,783. Fundraising expenses 0. Total expenses 2,542,443. Form 990, Part XI, line 9: Auxiliary Net Income -2,728. Change in Sunrise Receivable -238,345.