2020-11-09T15:17:15-06:00 2019-12-31 450250958 Eide Bailly LLP 1730 Burnt Boat Loop Ste 100 Bismarck ND 585030886 990 2019-01-01 450458242 Southwest Healthcare Services SOUT 7015235555 802 2nd St NW Bowman ND 58623 Amanda Loughman CFO 7015235555 2020-11-09 1 Lisa Chaffee CPA P00193453 7012551091 2020-11-09 63.157.195.138 2020-11-09 14:49:02 CS P DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 DEA5AAEEBA04E2AF66A8E14BCCBEC2FC2C377148 2019 2021-01-29 14:40:06Z Amanda Loughman 802 2nd St NW Bowman ND 58623 14562283 0 X www.swhealthcare.net X 2000 ND Southwest Healthcare Services is organized to provide quality health care services. 9 7 185 170 0 0 512150 991595 13277619 13206846 35788 25984 -17289 -12849 13808268 14211576 0 0 0 0 7356834 7846837 0 0 4300 7560651 7642295 14917485 15489132 -1109217 -1277556 38582188 36714299 31236238 30551979 7345950 6162320 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. 0 1 13208467 13207755 Southwest Healthcare Services (Southwest) consists of a 23-bed acute care hospital, 40-bed nursing facility, 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, 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, 2019 was $71,656, which was calculated by multiplying the ratio of cost to gross charges by the gross uncompensated charges associated with providing charity care to patients.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. 13208467 1 1 0 0 0 0 0 0 1 1 1 0 0 0 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 1 0 0 0 0 0 0 0 0 1 39 0 1 185 1 0 0 0 0 0 1 1 0 0 0 0 0 0 X 9 7 1 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 Matthew Feller Physician/Medical Director 40.00 X 422799 0 23248 Gerald Weisner CEO 40.00 X 232108 0 23248 Christine Peterson NP Trustee 40.00 X 187783 0 0 William Arban Physician (Jun-Dec) 40.00 X 172313 0 8749 Patricia Gilbert Physicians Assistant 40.00 X 150017 0 0 Carol Cornelius Pharmacist 40.00 X 117281 0 6000 Amie Kalina Registered Nurse 40.00 X 101223 0 6000 Sasha Ruggles CFO (Jan-Jul) 40.00 X 85322 0 5961 Amanda Loughman CFO (Jul-Dec) 40.00 X 47851 0 3868 Roger Walter President (Jan-Apr) 1.00 X X 0 0 0 Julie Lockert Secr. (Jan-Apr)/President (Apr-Dec) 1.00 X X 0 0 0 Duane Bowman Vice President 1.00 X X 0 0 0 Shonda Schwartz Trustee (Jan-Apr)/Secretary (Apr-Dec) 1.00 X X 0 0 0 Dan Powell Trustee 1.00 X 0 0 0 Teran Doerr Trustee 1.00 X 0 0 0 Andrew Weiss Trustee 1.00 X 0 0 0 Tami Gilbert Trustee 1.00 X 0 0 0 Chanell Walby Trustee (Apr-Dec) 1.00 X 0 0 0 1516697 0 77074 7 0 1 0 Rehab Visions 11623 Arbor Street Ste 201 Omaha NE 68144 Contract Staff 233451 National Medical Resources 2792 E Broadway Ave Bismarck ND 58501 Contract Staff 202960 DTN Staffing LLC 1200 Collins Ave Bismarck ND 58554 Contract Staff 166064 Prime Time Healthcare LLC PO Box 3544 Omaha NE 681030544 Contract Staff 127935 4 48404 480292 462899 43693 991595 Patient & Resident Service Revenu 621110 12551305 12551305 Pharmacy Revenue 446110 508285 508285 Supporting Revenue 900099 147256 147256 13206846 12607 12607 311273 297896 13377 13377 13377 39053 48404 52811 -13758 -13758 909 0 909 909 14211576 13207755 0 12226 X 589609 182640 406969 12978 12978 6092144 5458151 633993 671957 530336 141621 480149 408471 71678 6358 6358 50164 50164 2405794 2092370 313424 60658 60658 256251 190608 65643 311356 311356 319951 245030 74921 84963 63980 20983 1597 1597 506490 506490 2539714 2539714 85573 85573 Medical Supplies 689658 689658 Dietary Food and Supple 175127 175127 Bad Debts 76686 76686 Dues and Subscriptions 67461 36228 31233 4494 194 4300 15489132 13208467 2276365 4300 686320 546470 32507 20122 2203118 1999440 269851 273764 51425 33109 48473718 16721575 33687333 31752143 1077159 1345766 574475 743485 38582188 36714299 1053500 1480879 1742 1779 29771996 28798321 409000 271000 31236238 30551979 X 6642179 5296164 703771 866156 7345950 6162320 38582188 36714299 X -1277556 96500 -2574 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 1 16038 6874 4300 18612 1 X 127112 13595 13595 127112 127112 23230 23230 127112 127112 6469 6469 127112 127112 7275 7275 127112 127112 725 725 127112 0.00000 1.00000 0.00000 1 0 75488 75488 41357267 12026706 29330561 7037323 4694869 2342454 3640 3640 31752143 Estimated Third-Party Payor Settlements 271000 271000 X 14310320 96500 96500 14213820 -2244 -2244 14211576 15493950 9118 9118 15484832 4300 4300 15489132 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 $1,779 and $1,742 at December 31, 2019 and 2018. 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 6,874. Fundraising Expenses reported in Revenue on Form 990 -9,118. Part XII, Line 2d - Other Adjustments: Fundraising Expenses reported in Revenue on Form 990 9,118. Part XII, Line 4b - Other Adjustments: Auxiliary Expenses 4,300. Celebrity Waiter 87457 48404 39053 43693 500 6240 2378 87457 48404 39053 43693 500 6240 2378 52811 -13758 1 1 X 1 X 1 X 1 1 1 0 1 1 78000 78000 0.00500 2570395 2396069 174326 0.01130 2648395 2396069 252326 0.01630 8993 8993 0.00060 3465688 1923807 1541881 0.09950 3474681 1923807 1550874 0.10010 6123076 4319876 1803200 0.11640 4890 4890 0.00030 450 450 0.00000 5340 5340 0.00030 1 352978 70596 4011664 4050924 -39260 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 19 1 0 0 1 X http://swhealthcare.net/events/chna.html X See Part V, Section C X 1 19 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 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.We tried to address all three of the top concerns and made the following actions. In spring of 2019, a physician was recruited and began full-time employment in June 2019. In 2019, we provided six employment opportunities that resulted in the relocation of the employee. Four of these had young children and two of these have started families after relocating. Our mental health collaboration efforts with the Center for Psychiatric Care was fully operational through 2019 and patients were able to utilize the services every Thursday. 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 6a: The Organization's Community Benefit Report is contained in their annual meeting booklet. The annual meeting booklets are available at our facilities. 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 16 and 17 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 2019 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. X X 0 0 0 0 0 0 0 0 0 Matthew Feller Physician/Medical Director 422799 0 0 0 0 0 0 0 23248 0 446047 0 0 0 Gerald Weisner CEO 226076 0 0 0 6032 0 0 0 23248 0 255356 0 0 0 Christine Peterson NP Trustee 172817 0 0 0 14966 0 0 0 2466 0 190249 0 0 0 William Arban Physician (Jun-Dec) 159463 0 0 0 12850 0 0 0 9249 0 181562 0 0 0 Patricia Gilbert Physicians Assistant 146487 0 0 0 3530 0 0 0 2590 0 152607 0 0 0 Susan Powell Susan is the wife of board member Dan Powell 12978 Compensation 0 Christine Peterson Christine Peterson is the sister of CFO Sasha Ruggles. 190249 Compensation 0 Sasha Ruggles CFO and Sister to Christine Peterson 91283 Compensation 0 X Auction Items Donated 131 43693 Donor provided FMV 0 0 0 0 Form 990, Part III, line 3 The organization no longer offers outpatient therapy services in 2019. 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 374,682. Management and general expenses 122,452. Fundraising expenses 0. Total expenses 497,134. Purchased Services and Recruitment: Program service expenses 260,891. Management and general expenses 55,482. Fundraising expenses 0. Total expenses 316,373. Professional Fees and Consulting: Program service expenses 1,456,797. Management and general expenses 135,490. Fundraising expenses 0. Total expenses 1,592,287. Form 990, Part XI, line 9: Auxiliary Net Income -2,574.