SOUTHWEST HEALTHCARE CORPORATION: Form 990, tax year 2020
View the entire original 990 at ProPublica ↗
- Organization
- SOUTHWEST HEALTHCARE CORPORATION (EIN 45-0458242)
- Tax period
- 2020-01-01 to 2020-12-31
- Filed
- 2021-10-11
- IRS object ID
- 202142849349300869
- Schema version
- 2020v4.1
- 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
- Form 990
- Schedule A
- Schedule B
- Schedule D
- Schedule G
- Schedule H
- Schedule J
- Schedule L
- Schedule M
- Schedule O
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2021-10-11T10:50:54-05:00 | ReturnTs |
| Tax Period End | 2020-12-31 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 450250958 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Eide Bailly LLP | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1730 Burnt Boat Loop Ste 100 | AddressLine1Txt |
| City | Bismarck | CityNm |
| State Abbreviation | ND | StateAbbreviationCd |
| ZIP | 585030886 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2020-01-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 450458242 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Southwest Healthcare Services | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | SOUT | BusinessNameControlTxt |
| Phone | 7015235555 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 802 2nd St NW | AddressLine1Txt |
| City | Bowman | CityNm |
| State Abbreviation | ND | StateAbbreviationCd |
| ZIP | 58623 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | Dennis Goebel | PersonNm |
| Person Title | CEO | PersonTitleTxt |
| Phone | 7015235555 | PhoneNum |
| Signature | 2021-10-08 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Signing Officer SigningOfficerGrp
Person Full Name PersonFullName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person First | Dennis | PersonFirstNm |
| Person Last | Goebel | PersonLastNm |
| Field | Value | IRS element (for citing) |
|---|---|---|
| SSN | 999009999 | SSN |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | Lisa Chaffee CPA | PreparerPersonNm |
| PTIN | P00193453 | PTIN |
| Phone | 7012551091 | PhoneNum |
| Preparation | 2021-10-08 | PreparationDt |
Additional Filer Information AdditionalFilerInformation
Trusted Customer TrustedCustomerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Trusted Customer | 2 | TrustedCustomerCd |
| Authentication Assurance Level | AAL1 | AuthenticationAssuranceLevelCd |
| Identity Assurance Level | IAL1 | IdentityAssuranceLevelCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2020 | TaxYr |
| Build TS | 2022-09-23 18:48:47Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | Dennis Goebel | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 802 2nd St NW | AddressLine1Txt |
| City | Bowman | CityNm |
| State Abbreviation | ND | StateAbbreviationCd |
| ZIP | 58623 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $15,261,930 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | www.swhealthcare.net | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 2000 | FormationYr |
| Legal Domicile State | ND | LegalDomicileStateCd |
| Activity Or Mission | Southwest Healthcare Services is organized to provide quality health care services. | ActivityOrMissionDesc |
| Voting Members Governing Body | 9 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 7 | VotingMembersIndependentCnt |
| Total Employee | 183 | TotalEmployeeCnt |
| Total Volunteers | 150 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $991,595 | PYContributionsGrantsAmt |
| CY Contributions Grants | $1,637,389 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $13,206,846 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $13,472,345 | CYProgramServiceRevenueAmt |
| PY Investment Income | $25,984 | PYInvestmentIncomeAmt |
| CY Investment Income | $114,704 | CYInvestmentIncomeAmt |
| PY Other Revenue | -$12,849 | PYOtherRevenueAmt |
| CY Other Revenue | -$1,667 | CYOtherRevenueAmt |
| PY Total Revenue | $14,211,576 | PYTotalRevenueAmt |
| CY Total Revenue | $15,222,771 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $0 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $0 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $7,846,837 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $7,421,218 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $2,126 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $7,642,295 | PYOtherExpensesAmt |
| CY Other Expenses | $8,193,759 | CYOtherExpensesAmt |
| PY Total Expenses | $15,489,132 | PYTotalExpensesAmt |
| CY Total Expenses | $15,614,977 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | -$1,277,556 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | -$392,206 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $36,714,299 | TotalAssetsBOYAmt |
| Total Assets EOY | $39,058,820 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $30,551,979 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $33,184,732 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $6,162,320 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $5,874,088 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | 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. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $13,485,430 | ExpenseAmt |
| Revenue | $13,473,016 | RevenueAmt |
| Desc | Southwest Healthcare Services (Southwest) consists of a 23-bed acute care hospital, 34-bed nursing facility, 7-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, nursing facility, 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, 2020 was $88,000. This year was one of the highest for providing charity care.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 starting in March 2020, we were unable to do as much community outreach compared to prior years. Our fall health fair was canceled, and many sporting events and other community events that our ambulance and sports medicine would volunteer for was canceled. This reduced our community benefit substantially. Although Southwest Healthcare Services was unable to provide community benefits through sporting events and health fairs in 2020, we were crucial to providing COVID-19 screening and treatment for the community. Our community spiked in COVID-19 cases in October and November 2020, and we were able to detect most of these cases through our clinic or emergency room. Many times, we were able to provide the inpatient care to the patient as well. | Desc |
| Total Program Service Expenses | $13,485,430 | 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 | Yes (1) | 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 | 0 | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | Yes (1) | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | Yes (1) | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | 0 | 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 | Yes (1) | FundraisingActivitiesInd |
| Gaming Activities | 0 | GamingActivitiesInd |
| Operate Hospital | Yes (1) | OperateHospitalInd |
| Audited Financial Stmt Att | Yes (1) | AuditedFinancialStmtAttInd |
| Grants To Organizations | 0 | GrantsToOrganizationsInd |
| Grants To Individuals | 0 | 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 | Yes (1) | BusinessRlnWithFamMemInd |
| Business Rln With35 Ctrl Ent | 0 | BusinessRlnWith35CtrlEntInd |
| Deductible Non Cash Contri | Yes (1) | DeductibleNonCashContriInd |
| Deductible Art Contribution | 0 | DeductibleArtContributionInd |
| Terminate Operations | 0 | TerminateOperationsInd |
| Partial Liquidation | 0 | PartialLiquidationInd |
| Disregarded Entity | 0 | DisregardedEntityInd |
| Related Entity | 0 | RelatedEntityInd |
| Related Organization Ctrl Ent | 0 | RelatedOrganizationCtrlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | 0 | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| IRP Document | 43 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (1) | BackupWthldComplianceInd |
| Employee | 183 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (1) | EmploymentTaxReturnsFiledInd |
| 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 | Yes (1) | QuidProQuoContributionsInd |
| Quid Pro Quo Contri Discl | Yes (1) | QuidProQuoContriDisclInd |
| 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 | 9 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 7 | IndependentVotingMemberCnt |
| Family Or Business Rln | Yes (1) | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | 0 | DelegationOfMgmtDutiesInd |
| Change To Org Documents | 0 | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | 0 | MembersOrStockholdersInd |
| Election Of Board Members | 0 | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | 0 | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (1) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | 0 | 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 | Yes (1) | CompensationProcessCEOInd |
| Compensation Process Other | Yes (1) | 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 | Amanda Loughman CFO | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 7015233214 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 802 2nd St NW | AddressLine1Txt |
| City | Bowman | CityNm |
| State Abbreviation | ND | StateAbbreviationCd |
| ZIP | 58623 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (15 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Highest Compensated EmployeeHighestCompensatedEmployeeInd |
|---|---|---|---|---|---|---|---|
| Julie Lockert | |||||||
| President | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| Duane Bowman | |||||||
| Vice President | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| Shonda Schwartz | |||||||
| Secretary | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| Dan Powell | |||||||
| Trustee | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| Christine Peterson NP | |||||||
| Trustee | 40.00 | Yes (X) | $182,973 | $0 | $0 | ||
| Teran Doerr | |||||||
| Trustee | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| Andrew Weiss | |||||||
| Trustee | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| Tami Gilbert | |||||||
| Trustee | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| Chanell Walby | |||||||
| Trustee | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| Gerald Weisner | |||||||
| CEO (Jan-Feb) | 40.00 | Yes (X) | $38,114 | $0 | $4,461 | ||
| Robert Letson | |||||||
| Interim CEO (Mar-Nov) | 40.00 | Yes (X) | $97,750 | $0 | $0 | ||
| Amanda Loughman | |||||||
| CFO | 40.00 | Yes (X) | $101,488 | $0 | $14,086 | ||
| William Arban | |||||||
| Physician (Jan-Apr) | 40.00 | $168,271 | $0 | $13,384 | Yes (X) | ||
| Matthew Feller | |||||||
| Physician/Medical Director (Jan-Jul) | 40.00 | $276,937 | $0 | $15,615 | Yes (X) | ||
| Patricia Gilbert | |||||||
| Physicians Assistant | 40.00 | $151,242 | $0 | $0 | Yes (X) | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $1,016,775 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $0 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $47,546 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 5 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | 0 | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (1) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | 0 | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (4 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1Txt | CityContractorAddress/USAddress/CityNm | State AbbreviationContractorAddress/USAddress/StateAbbreviationCd | ZIPContractorAddress/USAddress/ZIPCd | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| National Medical Resources | |||||
| 2792 E Broadway Ave | Bismarck | ND | 58501 | Contract Staff | $708,035 |
| DTN Staffing LLC | |||||
| 1200 Collins Ave | Bismarck | ND | 58554 | Contract Staff | $418,969 |
| Rehab Visions | |||||
| 11623 Arbor Street Ste 201 | Omaha | NE | 68144 | Contract Staff | $403,127 |
| Homestead Recruiters Inc | |||||
| 821 Senior Ave | Dickinson | ND | 58601 | Contract Staff | $154,502 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 4 | CntrctRcvdGreaterThan100KCnt |
| Fundraising | $45,643 | FundraisingAmt |
| Government Grants | $1,162,497 | GovernmentGrantsAmt |
| All Other Contributions | $429,249 | AllOtherContributionsAmt |
| Noncash Contributions | $26,366 | NoncashContributionsAmt |
| Total Contributions | $1,637,389 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (3 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| Patient & Resident Service Revenu | 621110 | $12,675,489 | $12,675,489 |
| Pharmacy Revenue | 446110 | $548,644 | $548,644 |
| Supporting Revenue | 900099 | $248,212 | $248,212 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $13,472,345 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $18,939 | TotalRevenueColumnAmt |
| Exclusion | $18,939 | ExclusionAmt |
Gross Amount Sales Assets GrossAmountSalesAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $9,560 | SecuritiesAmt |
| Other | $86,205 | OtherAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $0 | SecuritiesAmt |
| Other | $0 | OtherAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $9,560 | SecuritiesAmt |
| Other | $86,205 | OtherAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $95,765 | TotalRevenueColumnAmt |
| Exclusion | $95,765 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Fundraising Gross Income | $36,821 | FundraisingGrossIncomeAmt |
| Contri Rpt Fundraising Event | $45,643 | ContriRptFundraisingEventAmt |
| Fundraising Direct Expenses | $39,159 | FundraisingDirectExpensesAmt |
Net Incm From Fundraising Evt NetIncmFromFundraisingEvtGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -$2,338 | TotalRevenueColumnAmt |
| Exclusion | -$2,338 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Sales Of Inventory | $671 | GrossSalesOfInventoryAmt |
| Cost Of Goods Sold | $0 | CostOfGoodsSoldAmt |
Net Income Or Loss NetIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $671 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $671 | RelatedOrExemptFuncIncomeAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $15,222,771 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $13,473,016 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $112,366 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part IX | Yes (X) | InfoInScheduleOPartIXInd |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $438,873 | TotalAmt |
| Program Services | $175,654 | ProgramServicesAmt |
| Management And General | $263,219 | ManagementAndGeneralAmt |
Comp Disqual Persons CompDisqualPersonsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $16,029 | TotalAmt |
| Program Services | $16,029 | ProgramServicesAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $5,780,697 | TotalAmt |
| Program Services | $5,283,840 | ProgramServicesAmt |
| Management And General | $496,857 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $723,340 | TotalAmt |
| Program Services | $572,719 | ProgramServicesAmt |
| Management And General | $150,621 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $462,279 | TotalAmt |
| Program Services | $405,881 | ProgramServicesAmt |
| Management And General | $56,398 | ManagementAndGeneralAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $7,503 | TotalAmt |
| Management And General | $7,503 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $53,689 | TotalAmt |
| Management And General | $53,689 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,052,585 | TotalAmt |
| Program Services | $2,694,165 | ProgramServicesAmt |
| Management And General | $358,420 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $71,678 | TotalAmt |
| Management And General | $71,678 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $205,660 | TotalAmt |
| Program Services | $150,890 | ProgramServicesAmt |
| Management And General | $54,770 | ManagementAndGeneralAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $283,939 | TotalAmt |
| Management And General | $283,939 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $317,327 | TotalAmt |
| Program Services | $252,278 | ProgramServicesAmt |
| Management And General | $65,049 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $53,796 | TotalAmt |
| Program Services | $44,720 | ProgramServicesAmt |
| Management And General | $9,076 | ManagementAndGeneralAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $66 | TotalAmt |
| Management And General | $66 | ManagementAndGeneralAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $477,002 | TotalAmt |
| Program Services | $477,002 | ProgramServicesAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,506,729 | TotalAmt |
| Program Services | $2,357,387 | ProgramServicesAmt |
| Management And General | $149,342 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $85,989 | TotalAmt |
| Management And General | $85,989 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| Medical Supplies | $815,198 | $815,198 | |
| Dietary Food and Supple | $165,197 | $165,197 | |
| Dues and Subscriptions | $57,064 | $36,259 | $20,805 |
| Bad Debts | $32,211 | $32,211 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $8,126 | TotalAmt |
| Program Services | $6,000 | ProgramServicesAmt |
| Fundraising | $2,126 | FundraisingAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $15,614,977 | TotalAmt |
| Program Services | $13,485,430 | ProgramServicesAmt |
| Management And General | $2,127,421 | ManagementAndGeneralAmt |
| Fundraising | $2,126 | FundraisingAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $546,470 | BOYAmt |
| EOY | $4,645,778 | EOYAmt |
Pledges And Grants Receivable PledgesAndGrantsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $20,122 | BOYAmt |
| EOY | $13,984 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,999,440 | BOYAmt |
| EOY | $1,525,306 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $273,764 | BOYAmt |
| EOY | $296,915 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $33,109 | BOYAmt |
| EOY | $46,440 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $48,679,178 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $19,138,450 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $31,752,143 | BOYAmt |
| EOY | $29,540,728 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,345,766 | BOYAmt |
| EOY | $1,707,867 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $743,485 | BOYAmt |
| EOY | $1,281,802 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $36,714,299 | BOYAmt |
| EOY | $39,058,820 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,480,879 | BOYAmt |
| EOY | $1,134,916 | EOYAmt |
Deferred Revenue DeferredRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $2,998,100 | EOYAmt |
Escrow Account Liability EscrowAccountLiabilityGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,779 | BOYAmt |
| EOY | $2,479 | EOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $28,798,321 | BOYAmt |
| EOY | $27,817,537 | EOYAmt |
Unsecured Notes Loans Payable UnsecuredNotesLoansPayableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $1,231,700 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $271,000 | BOYAmt |
| EOY | $0 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $30,551,979 | BOYAmt |
| EOY | $33,184,732 | 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 | $5,296,164 | BOYAmt |
| EOY | $4,893,990 | EOYAmt |
Donor Restriction Net Assets DonorRestrictionNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $866,156 | BOYAmt |
| EOY | $980,098 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $6,162,320 | BOYAmt |
| EOY | $5,874,088 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $36,714,299 | BOYAmt |
| EOY | $39,058,820 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | Yes (X) | InfoInScheduleOPartXIInd |
| Reconcilation Revenue Expnss | -$392,206 | ReconcilationRevenueExpnssAmt |
| Net Unrlzd Gains Losses Invst | $102,123 | NetUnrlzdGainsLossesInvstAmt |
| Other Changes In Net Assets | $1,851 | OtherChangesInNetAssetsAmt |
| 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) |
|---|---|---|
| Separate Basis Fincl Stmt | Yes (X) | SeparateBasisFinclStmtInd |
| 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) |
|---|---|---|
| Hospital | Yes (X) | HospitalInd |
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
| Field | Value | IRS element (for citing) |
|---|---|---|
| Agent Trustee Etc | Yes (1) | AgentTrusteeEtcInd |
| Beginning Balance | $18,612 | BeginningBalanceAmt |
| Additions During Year | $275 | AdditionsDuringYearAmt |
| Distributions During Year | $2,126 | DistributionsDuringYearAmt |
| Ending Balance | $16,761 | EndingBalanceAmt |
| Incl Escrow Custodial Acct Liab | Yes (1) | InclEscrowCustodialAcctLiabInd |
| Explanation Provided | Yes (X) | ExplanationProvidedInd |
CY Endwmt Fund CYEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $127,112 | BeginningYearBalanceAmt |
| Investment Earnings Or Losses | $10,556 | InvestmentEarningsOrLossesAmt |
| Other Expenditures | $10,556 | OtherExpendituresAmt |
| End Year Balance | $127,112 | EndYearBalanceAmt |
CY Minus1 Yr Endwmt Fund CYMinus1YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $127,112 | BeginningYearBalanceAmt |
| Investment Earnings Or Losses | $13,595 | InvestmentEarningsOrLossesAmt |
| Other Expenditures | $13,595 | OtherExpendituresAmt |
| End Year Balance | $127,112 | EndYearBalanceAmt |
CY Minus2 Yr Endwmt Fund CYMinus2YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $127,112 | BeginningYearBalanceAmt |
| Investment Earnings Or Losses | $23,230 | InvestmentEarningsOrLossesAmt |
| Other Expenditures | $23,230 | OtherExpendituresAmt |
| End Year Balance | $127,112 | EndYearBalanceAmt |
CY Minus3 Yr Endwmt Fund CYMinus3YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $127,112 | BeginningYearBalanceAmt |
| Investment Earnings Or Losses | $6,469 | InvestmentEarningsOrLossesAmt |
| Other Expenditures | $6,469 | OtherExpendituresAmt |
| End Year Balance | $127,112 | EndYearBalanceAmt |
CY Minus4 Yr Endwmt Fund CYMinus4YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $127,112 | BeginningYearBalanceAmt |
| Investment Earnings Or Losses | $7,275 | InvestmentEarningsOrLossesAmt |
| Other Expenditures | $7,275 | OtherExpendituresAmt |
| End Year Balance | $127,112 | EndYearBalanceAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Board Designated Balance EOY | 0.00000 | BoardDesignatedBalanceEOYPct |
| Prmnnt Endowment Balance EOY | 1.00000 | PrmnntEndowmentBalanceEOYPct |
| Term Endowment Balance EOY | 0.00000 | TermEndowmentBalanceEOYPct |
| Endowments Held Unrelated Org | Yes (1) | EndowmentsHeldUnrelatedOrgInd |
| Endowments Held Related Org | 0 | EndowmentsHeldRelatedOrgInd |
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $75,488 | OtherCostOrOtherBasisAmt |
| Book Value | $75,488 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $41,373,576 | OtherCostOrOtherBasisAmt |
| Depreciation | $14,052,626 | DepreciationAmt |
| Book Value | $27,320,950 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $7,230,114 | OtherCostOrOtherBasisAmt |
| Depreciation | $5,085,824 | DepreciationAmt |
| Book Value | $2,144,290 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $29,540,728 | TotalBookValueLandBuildingsAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
| Total Rev Etc Audited Fincl Stmt | $15,363,778 | TotalRevEtcAuditedFinclStmtAmt |
| Net Unrealized Gains Invst | $102,123 | NetUnrealizedGainsInvstAmt |
| Revenue Not Reported | $102,123 | RevenueNotReportedAmt |
| Revenue Subtotal | $15,261,655 | RevenueSubtotalAmt |
| Other Revenues Not Included | -$38,884 | OtherRevenuesNotIncludedAmt |
| Revenue Not Reported Fincl Stmt | -$38,884 | RevenueNotReportedFinclStmtAmt |
| Total Revenue Per Form990 | $15,222,771 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $15,652,010 | TotExpnsEtcAuditedFinclStmtAmt |
| Other Expenses Included | $39,159 | OtherExpensesIncludedAmt |
| Expenses Not Reported | $39,159 | ExpensesNotReportedAmt |
| Expenses Subtotal | $15,612,851 | ExpensesSubtotalAmt |
| Other Expenses Not Included | $2,126 | OtherExpensesNotIncludedAmt |
| Expenses Not Rpt Fincl Stmt | $2,126 | ExpensesNotRptFinclStmtAmt |
| Total Expenses Per Form990 | $15,614,977 | TotalExpensesPerForm990Amt |
Supplemental Information Detail SupplementalInformationDetail (7 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| 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 the residents. These funds are included in cash and accounts payable in the financial statements. Resident trust funds totaled $2,479 and $1,779 at December 31, 2020 and 2019. |
| Part V, Line 4: | Endowments held and administered by Southwest Healthcare Services: The earnings from the $127,112 are for hospital operations and to support assisted living, as necessary. The principal of $127,112 is permanently restricted. |
| 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 4b - Other Adjustments: | Auxiliary Revenue 275. Fundraising Expenses reported in Revenue on Form 990 -39,159. |
| Part XII, Line 2d - Other Adjustments: | Fundraising Expenses reported in Revenue on Form 990 39,159. |
| Part XII, Line 4b - Other Adjustments: | Auxiliary Expenses 2,126. |
Schedule G IRS990ScheduleG
Fundraising Event Information FundraisingEventInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Event1 | Celebrity Waiter | Event1Nm |
| Gross Receipts Event1 | $82,464 | GrossReceiptsEvent1Amt |
| Charitable Contri Event1 | $45,643 | CharitableContriEvent1Amt |
| Gross Revenue Event1 | $36,821 | GrossRevenueEvent1Amt |
| Cash Prizes Event1 | $1,675 | CashPrizesEvent1Amt |
| Non Cash Prizes Event1 | $26,407 | NonCashPrizesEvent1Amt |
| Rent Facility Costs Event1 | $500 | RentFacilityCostsEvent1Amt |
| Food And Beverage Event1 | $5,635 | FoodAndBeverageEvent1Amt |
| Entertainment Event1 | $1,200 | EntertainmentEvent1Amt |
| Other Direct Expenses Event1 | $3,742 | OtherDirectExpensesEvent1Amt |
| Gross Receipts Total | $82,464 | GrossReceiptsTotalAmt |
| Charitable Contributions Tot | $45,643 | CharitableContributionsTotAmt |
| Gross Revenue Total Events | $36,821 | GrossRevenueTotalEventsAmt |
| Cash Prizes Total Events | $1,675 | CashPrizesTotalEventsAmt |
| Non Cash Prizes Total Events | $26,407 | NonCashPrizesTotalEventsAmt |
| Rent Fclty Costs Total Events | $500 | RentFcltyCostsTotalEventsAmt |
| Food And Beverage Total Events | $5,635 | FoodAndBeverageTotalEventsAmt |
| Entertainment Total Events | $1,200 | EntertainmentTotalEventsAmt |
| Oth Direct Expnss Total Events | $3,742 | OthDirectExpnssTotalEventsAmt |
| Direct Expense Summary Events | $39,159 | DirectExpenseSummaryEventsAmt |
| Net Income Summary | -$2,338 | NetIncomeSummaryAmt |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Assistance Policy | Yes (1) | FinancialAssistancePolicyInd |
| Written Policy | Yes (1) | WrittenPolicyInd |
| All Hospitals Policy | Yes (X) | AllHospitalsPolicyInd |
| FPG Reference Free Care | Yes (1) | FPGReferenceFreeCareInd |
| Percent100 | Yes (X) | Percent100Ind |
| FPG Reference Discounted Care | Yes (1) | FPGReferenceDiscountedCareInd |
| Percent200 D | Yes (X) | Percent200DInd |
| Free Care Medically Indigent | Yes (1) | FreeCareMedicallyIndigentInd |
| Financial Assistance Budget | Yes (1) | FinancialAssistanceBudgetInd |
| Expenses Exceed Budget | Yes (1) | ExpensesExceedBudgetInd |
| Unable To Provide Care | 0 | UnableToProvideCareInd |
| Annual Community Bnft Report | 0 | AnnualCommunityBnftReportInd |
Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $88,000 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $88,000 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00560 | TotalExpensePct |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $2,610,381 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $2,540,568 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $69,813 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00450 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $2,698,381 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $2,540,568 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $157,813 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.01010 | TotalExpensePct |
Community Health Services CommunityHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $19,015 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $3,075 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $15,940 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00100 | TotalExpensePct |
Subsidized Health Services SubsidizedHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $3,890,664 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $1,913,031 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $1,977,633 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.12660 | TotalExpensePct |
Total Other Benefits TotalOtherBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $3,909,679 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $1,916,106 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $1,993,573 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.12760 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $6,608,060 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $4,456,674 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $2,151,386 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.13770 | TotalExpensePct |
Health Improvement Advocacy HealthImprovementAdvocacyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 3 | ActivitiesOrProgramsCnt |
| Persons Served | 10 | PersonsServedCnt |
| Total Community Benefit Expns | $18,043 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $5,250 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $12,793 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00080 | TotalExpensePct |
Total Communtity Building Acty TotalCommuntityBuildingActyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 3 | ActivitiesOrProgramsCnt |
| Persons Served | 10 | PersonsServedCnt |
| Total Community Benefit Expns | $18,043 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $5,250 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $12,793 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00080 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | Yes (1) | BadDebtExpenseReportedInd |
| Bad Debt Expense | $234,015 | BadDebtExpenseAmt |
| Bad Debt Expense Attributable | $46,803 | BadDebtExpenseAttributableAmt |
| Reimbursed By Medicare | $4,058,662 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $4,021,807 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | $36,855 | MedicareSurplusOrShortfallAmt |
Costing Methodology Used CostingMethodologyUsedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | Yes (X) | OtherInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | Yes (1) | WrittenDebtCollectionPolicyInd |
| Financial Assistance Prvsn | Yes (1) | FinancialAssistancePrvsnInd |
| Hospital Facilities | 1 | HospitalFacilitiesCnt |
Hospital Facilities HospitalFacilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Southwest Healthcare Services | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 14 6th Ave SW | AddressLine1Txt |
| City | Bowman | CityNm |
| State Abbreviation | ND | StateAbbreviationCd |
| ZIP | 58623 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| State License | 5006 | StateLicenseNum |
| Licensed Hospital | Yes (X) | LicensedHospitalInd |
| General Medical And Surgical | Yes (X) | GeneralMedicalAndSurgicalInd |
| Critical Access Hospital | Yes (X) | CriticalAccessHospitalInd |
| Emergency Room24 Hrs | Yes (X) | EmergencyRoom24HrsInd |
| Other | Rural Health Clinic | OtherDesc |
Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Southwest Healthcare Services | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
| First Licensed CY Or PY | 0 | FirstLicensedCYOrPYInd |
| Tax Exempt Hospital CY Or PY | 0 | TaxExemptHospitalCYOrPYInd |
| CHNA Conducted | Yes (1) | CHNAConductedInd |
| Community Definition | Yes (X) | CommunityDefinitionInd |
| Community Demographics | Yes (X) | CommunityDemographicsInd |
| Existing Resources | Yes (X) | ExistingResourcesInd |
| How Data Obtained | Yes (X) | HowDataObtainedInd |
| Community Health Needs | Yes (X) | CommunityHealthNeedsInd |
| Other Health Issues | Yes (X) | OtherHealthIssuesInd |
| Community Hlth Needs Id Process | Yes (X) | CommunityHlthNeedsIdProcessInd |
| Consulting Process | Yes (X) | ConsultingProcessInd |
| Prior CHNA Impact | Yes (X) | PriorCHNAImpactInd |
| CHNA Conducted | 19 | CHNAConductedYr |
| Take Into Account Others Input | Yes (1) | TakeIntoAccountOthersInputInd |
| CHNA Conducted With Other Fclts | 0 | CHNAConductedWithOtherFcltsInd |
| CHNA Conducted With Non Fclts | 0 | CHNAConductedWithNonFcltsInd |
| CHNA Report Widely Available | Yes (1) | CHNAReportWidelyAvailableInd |
| Rpt Available On Own Website | Yes (X) | RptAvailableOnOwnWebsiteInd |
| Own Website URL | http://swhealthcare.net/events/chna.html | OwnWebsiteURLTxt |
| Other Website | Yes (X) | OtherWebsiteInd |
| Other Website URL | See Part V, Section C | OtherWebsiteURLTxt |
| Paper Copy Public Inspection | Yes (X) | PaperCopyPublicInspectionInd |
| Implementation Strategy Adopt | Yes (1) | ImplementationStrategyAdoptInd |
| Implementation Strategy Adpt | 19 | ImplementationStrategyAdptYr |
| Strategy Posted Website | Yes (1) | StrategyPostedWebsiteInd |
| Strategy Website URL | http://swhealthcare.net/events/chna.html | StrategyWebsiteURLTxt |
| Organization Incur Excise Tax | 0 | OrganizationIncurExciseTaxInd |
| Elig Criteria Explained | Yes (1) | EligCriteriaExplainedInd |
| FPG Family Incm Lmt Free Dscnt | Yes (X) | FPGFamilyIncmLmtFreeDscntInd |
| FPG Family Incm Lmt Free Care | 100.000000000000 | FPGFamilyIncmLmtFreeCarePct |
| FPG Family Incm Lmt Dscnt Care | 200.000000000000 | FPGFamilyIncmLmtDscntCarePct |
| Asset Level Criteria | Yes (X) | AssetLevelCriteriaInd |
| Medical Indigency Criteria | Yes (X) | MedicalIndigencyCriteriaInd |
| Insurance Status Criteria | Yes (X) | InsuranceStatusCriteriaInd |
| Underinsurance Stat Criteria | Yes (X) | UnderinsuranceStatCriteriaInd |
| Other Criteria | Yes (X) | OtherCriteriaInd |
| Explained Basis | Yes (1) | ExplainedBasisInd |
| App Financial Asst Expln | Yes (1) | AppFinancialAsstExplnInd |
| Described Info | Yes (X) | DescribedInfoInd |
| Described Suprt Doc | Yes (X) | DescribedSuprtDocInd |
| Provided Hospital Contact | Yes (X) | ProvidedHospitalContactInd |
| Provided Nonprofit Contact | Yes (X) | ProvidedNonprofitContactInd |
| Includes Publicity Measures | Yes (1) | IncludesPublicityMeasuresInd |
| FAP Available On Website | Yes (X) | FAPAvailableOnWebsiteInd |
| FAP Available On Website URL | See Part V, Section C | FAPAvailableOnWebsiteURLTxt |
| FAP App Available On Website | Yes (X) | FAPAppAvailableOnWebsiteInd |
| FAP App Available On Website URL | See Part V, Section C | FAPAppAvailableOnWebsiteURLTxt |
| FAP Summary On Website | Yes (X) | FAPSummaryOnWebsiteInd |
| FAP Summary On Website URL | See Part V, Section C | FAPSummaryOnWebsiteURLTxt |
| FAP Avlbl On Request No Charge | Yes (X) | FAPAvlblOnRequestNoChargeInd |
| FAP App Avlbl On Request No Chrg | Yes (X) | FAPAppAvlblOnRequestNoChrgInd |
| FAP Sum Avlbl On Request No Chrg | Yes (X) | FAPSumAvlblOnRequestNoChrgInd |
| Notified FAP Copy Bill Display | Yes (X) | NotifiedFAPCopyBillDisplayInd |
| Communtity Notified FAP | Yes (X) | CommuntityNotifiedFAPInd |
| Other Publicity | Yes (X) | OtherPublicityInd |
| FAP Actions On Nonpayment | Yes (1) | FAPActionsOnNonpaymentInd |
| Permit No Actions | Yes (X) | PermitNoActionsInd |
| Collection Activities | 0 | CollectionActivitiesInd |
| Provided Written Notice | Yes (X) | ProvidedWrittenNoticeInd |
| Made Effort Orally Notify | Yes (X) | MadeEffortOrallyNotifyInd |
| Processed FAP Application | Yes (X) | ProcessedFAPApplicationInd |
| Made Presumptive Elig Determ | Yes (X) | MadePresumptiveEligDetermInd |
| Nondis Emergency Care Policy | Yes (1) | NondisEmergencyCarePolicyInd |
| Look Back Medicare Private | Yes (X) | LookBackMedicarePrivateInd |
| Amounts Generally Billed | 0 | AmountsGenerallyBilledInd |
| Gross Charges | 0 | GrossChargesInd |
Supplemental Information SupplementalInformationGrp (8 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Southwest Healthcare Services | Part V, Section B, Line 5: A Community Advisory Committee was organized with specific individuals from the community served. Personal invitations were sent to organizations representing various community, business, educational and religious groups. Representatives from the local healthcare providers and the county public health department were included to bring in additional professional perspective. |
| Southwest Healthcare Services | Part V, Section B, Line 11: In the most recent CHNA conducted the following needs were identified and prioritized as the top three needs: ability to retain primary care providers; attracting and retaining young families; and availability of mental health services. Depression and anxiety was also identified as the fourth highest need.The organization will not be addressing depression and anxiety separately as this will be addressed partly by making mental health services available. As a healthcare organization, we will only be able to address this concern medically and by promoting the tele-psych services we currently offer.The need to retain primary care providers was identified as the top priority in the 2019 CHNA. In 2020, we signed on a physician to start employment January 1, 2021. In order to have full coverage, we are still recruiting for the second physician.Another need identified was attracting and retaining young families. We were able to recruit and retain one employee that has started a family after relocating.Our third highest prioritized need to increase the availability of mental health services has not changed in 2020. |
| 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 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 4 | FacilityNum |
Oth Hlth Care Fclts Not Hospital OthHlthCareFcltsNotHospitalGrp
Oth Hlth Care Fclts OthHlthCareFcltsGrp (4 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | FacilityFacilityTxt |
|---|---|---|---|---|
| 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 |
Supplemental Information Detail SupplementalInformationDetail (12 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| 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: | We review accounts on an individual basis before turning them over to bad debt. 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 charity care, they may have qualified. Southwest Healthcare Services does not refuse service to patients that generate bad debt. 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 11 and 12 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 agricultural based but in recent years the oil and gas industry has grown extensively. We anticipate that this will increase at an even greater pace in the next several years thus increasing the patient base that our organization will serve. 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 2017 of 2.3% in Bowman County, 2.6% in Slope County and 2.3% in Harding County and a median income in 2016 of $63,000 for our service area. In 2017, approximately 9.3% of the person's under the age of 65 were without health insurance. |
| 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. |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Compensation Survey | Yes (X) | CompensationSurveyInd |
| Board Or Committee Approval | Yes (X) | BoardOrCommitteeApprovalInd |
| Severance Payment | Yes (1) | 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 (4 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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Matthew Feller | ||||||||||||||
| Physician/Medical Director (Jan-Jul) | $276,937 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $15,615 | $0 | $292,552 | $0 | $0 | $0 |
| Christine Peterson NP | ||||||||||||||
| Trustee | $168,039 | $0 | $0 | $0 | $14,934 | $0 | $0 | $0 | $0 | $0 | $182,973 | $0 | $0 | $0 |
| William Arban | ||||||||||||||
| Physician (Jan-Apr) | $165,570 | $0 | $0 | $0 | $2,701 | $0 | $0 | $0 | $13,384 | $0 | $181,655 | $0 | $0 | $0 |
| Patricia Gilbert | ||||||||||||||
| Physicians Assistant | $147,565 | $0 | $0 | $0 | $3,677 | $0 | $0 | $0 | $0 | $0 | $151,242 | $0 | $0 | $0 |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | Part I, Line 4a | FormAndLineReferenceDesc |
| Explanation | Dr. William Arban received three months of severance pay equaling $69,230. Dr. Matthew Feller was paid a severance. He was paid through the end of his contract (which was approximately one month of pay) for an amount of $26,983. | ExplanationTxt |
Schedule L IRS990ScheduleL
Bus Tr Involve Interested Prsn BusTrInvolveInterestedPrsnGrp
Name Of Interested NameOfInterested
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | Susan Powell | PersonNm |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Relationship Description | Susan is the wife of board member Dan Powell | RelationshipDescriptionTxt |
| Transaction | $16,029 | TransactionAmt |
| Transaction | Compensation | TransactionDesc |
| Sharing Of Revenues | 0 | SharingOfRevenuesInd |
Schedule M IRS990ScheduleM
Other Non Cash Contri Table OtherNonCashContriTableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Non Cash Checkbox | Yes (X) | NonCashCheckboxInd |
| Desc | Auction Items Donated | Desc |
| Contribution | 163 | ContributionCnt |
| Noncash Contributions Rpt F990 | $26,366 | NoncashContributionsRptF990Amt |
| Method Of Determining Revenues | Donor provided FMV | MethodOfDeterminingRevenuesTxt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form8283 Received | 0 | Form8283ReceivedCnt |
| Any Property That Must Be Held | 0 | AnyPropertyThatMustBeHeldInd |
| Review Process Unusual NC Gifts | 0 | ReviewProcessUnusualNCGiftsInd |
| Third Parties Used | 0 | ThirdPartiesUsedInd |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (9 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Form 990, Part VI, Section A, line 1 | 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 2 | Christine Peterson is the sister of CFO Sasha Ruggles. |
| 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 367,571. Management and general expenses 174,896. Fundraising expenses 0. Total expenses 542,467. Purchased Services and Recruitment: Program service expenses 217,574. Management and general expenses 55,851. Fundraising expenses 0. Total expenses 273,425. Professional Fees and Consulting: Program service expenses 2,109,020. Management and general expenses 127,673. Fundraising expenses 0. Total expenses 2,236,693. |
| Form 990, Part XI, line 9: | Auxiliary Net Income 1,851. |
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