2016-02-15T11:07:04-06:00 2015-03-31 460403496 CASEY PETERSON & ASSOC 909 ST JOSEPH ST SUITE 101 RAPID CITY SD 57701 990 2014-04-01 260794602 WESTERN HORIZONS LIVING CENTERS WEST 7015674561 1000 HIGHWAY 12 HETTINGER ND 58639 NATHAN STADHEIM CFO 7015674561 2016-02-15 DEIDRE BUDAHL CPA P01273830 6053481930 2016-02-15 2014 2016-08-17 19:52:53Z JIM K LONG 1000 HIGHWAY 12 HETTINGER ND 58639 4092801 0 X WWW.WRHS.COM X 2007 ND TO ASSIST OUR NEIGHBORS IN ACHIEVING AND MAINTAINING THEIR HIGHEST LEVEL OF INDEPENDENCE. 10 10 92 10 0 0 88766 58475 3913771 4034326 2356 0 0 0 4004893 4092801 0 0 0 0 2483391 2824420 0 0 0 1474581 1151404 3957972 3975824 46921 116977 1411763 1476208 2600963 2548431 -1189200 -1072223 X THE MISSION OF WESTERN HORIZONS LIVING CENTERS IS TO ASSIST OUR NEIGHBORS IN ACHIEVING AND MAINTAINING THEIR HIGHEST LEVEL OF INDEPENDENCE IN A CARING AND RESPECTFUL ENVIRONMENT. 0 0 3230800 3578810 WESTERN HORIZONS LIVING CENTERS (WHLC) BEGAN ITS OPERATIONS OF LONG-TERM CARE SERVICES ON SEPTEMBER 1, 2007. IT WAS LICENSED BY THE NORTH DAKOTA DEPARTMENT OF HEALTH TO OPERATE 82 SKILLED NURSING BEDS AND 6 BASIC CARE BEDS. EFFECTIVE APRIL 1, 2008, WHLC SOLD 20 OF ITS LICENSED SKILLED NURSING BEDS AND EFFECTIVE OCTOBER 1, 2009, WHLC SOLD 8 ADDITIONAL BEDS. EFFECTIVE JULY 1, 2011, WHLC WAS APPROVED FOR A DECREASE IN NURSING FACILITY BEDS FROM 54 TO 50. IN ADDITION AND ALSO EFFECTIVE JULY 1, 2011, WHLC WAS APPROVED FOR AN INCREASE IN BASIC CARE BEDS FROM 6 TO 10. IN ADDITION TO THE BASIC DAILY ROUTINE CARE, STAFF ALSO PROVIDED PHYSICAL THERAPY, OCCUPATIONAL THERAPY, SPEECH THERAPY, ACTIVITIES, AND SOCIAL SERVICES TO ITS CLIENTS. ON AVERAGE, LONG-TERM CARE SERVICES WERE PROVIDED TO 41 RESIDENTS PER MONTH FOR THIS REPORTING PERIOD. THERE WERE 15,170 SKILLED NURSING DAYS WITH 62% OF THOSE DAYS BEING MEDICAID CERTIFIED. THERE WERE 3,445 BASIC CARE DAYS FOR THIS REPORTING PERIOD. THROUGHOUT THE YEAR, WHLC AND COMMUNITY INDIVIDUALS/GROUPS PROVIDED MANY VARIED FORMS OF PROGRAMMING, INCLUDING EXERCISE GROUPS, MUSICAL ENTERTAINMENT, BINGO, VAN TRIPS, COMMUNITY OUTINGS, SOCIAL EVENTS, MONTHLY BIRTHDAY PARTIES, EDUCATIONAL PROGRAMS, MOVIES AND BEDSIDE ACTIVITIES. LOCAL CLERGY AND FACILITY STAFF CONDUCTED REGULAR WORSHIP SERVICES AND BIBLE STUDIES FOR RESIDENTS. A GROUP OF LOCAL LADIES WEEKLY VOLUNTEER THEIR SERVICES IN HAIRDRESSING FOR THE RESIDENTS. 410616 437748 IT WAS ON APRIL 1, 2008 THAT WHLC BEGAN OPERATIONS OF A 16-UNIT ASSISTED LIVING FACILITY KNOWN AS WESTERN HORIZONS ASSISTED LIVING (WHAL). IT PROVIDES HANDICAP ACCESSIBLE BATHROOMS IN THE ROOMS, ELECTRIC DOOR OPENERS THROUGHOUT THE FACILITY, AND IS ALL ON ONE LEVEL TO PROVIDE EASY ACCESSIBILITY TO THE TENANTS. WHAL OPERATES CHARITABLY BY MEETING THE PHYSICAL, EMOTIONAL, RECREATIONAL, SOCIAL, RELIGIOUS, AND SIMILAR NEEDS OF ELDERLY PEOPLE. SOME OF THE ACTIVITIES INCLUDE CARD PLAYING, GARDENING, WEEKLY RELIGIOUS GATHERINGS, AND SOCIAL INTERACTION WITH EACH OTHER OR FAMILY VISITORS. STAFF ALSO PROVIDES OTHER HEALTH-RELATED SERVICES INCLUDING BATHING, HAIR, SKIN AND NAIL CARE, DRESSING, ASSISTANCE WITH MOBILITY, COMMUNICATION AND REMINDERS, MEDICATION MANAGEMENT, HOUSEKEEPING AND LAUNDRY SERVICES, MEAL PLANNING AND PREPARATION, EXERCISE PROGRAM, AND MONITORING BLOOD SUGARS, VITAL SIGNS AND OXYGEN. WHILE THERE HAS BEEN SOME TURNOVER THROUGHOUT THE YEAR DUE TO DEATH AND/OR THE TENANT NEEDING A HIGHER LEVEL OF CARE, WHAL HAS ENJOYED A 95% OCCUPANCY RATE AND HAS A LENGTHY WAITING LIST OF THOSE SEEKING ASSISTED LIVING SERVICES. ASSISTED LIVING SERVICES ARE OPEN TO ANY INDIVIDUAL WHO QUALIFIES FOR CARE. THERE ARE 17 TENANTS CURRENTLY RESIDING AT WHAL. STAFF HAVE CLOSE RELATIONSHIPS WITH REGIONAL AND COUNTY SOCIAL SERVICE WORKERS TO ASSIST IN THE APPLICATION PROCESS FOR MEDICAL ASSISTANCE. 3641416 1 1 0 0 0 0 0 0 1 0 1 0 0 0 1 1 1 1 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 17 0 1 92 1 0 0 0 0 0 0 0 0 0 0 X 10 10 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 0 0 0 X NATHAN STADHEIM 7015674561 1000 HIGHWAY 12 HETTINGER ND 58369 STEVE HEDSTROM WHLC REPRESENTATIVE 2.00 X 0 0 0 ALLEN MCINTYRE CHAIRMAN 2.00 X X 0 0 0 TERRY HENDERSON WHLC REPRESENTATIVE 2.00 X 0 0 0 LINDA WEAVER BRAATEN WHLC REPRESENTATIVE 2.00 X 0 0 0 KEITH KVANVIG WHLC REPRESENTATIVE 2.00 X 0 0 0 MAGNUS MEIER VICE CHAIR 2.00 X X 0 0 0 PASTOR RON NELSON WHLC REPRESENTATIVE 2.00 X 0 0 0 DR STACIE WELLMAN MEDICAL STAFF LIAISON 2.00 X 0 0 0 DR KENT HOERAUF MEDICAL DIRECTOR 2.00 X 0 0 0 BLANE CHAPMAN WHLC REPRESENTATIVE 2.00 X 0 0 0 CAROL FORDAHL SECRETARY/TREASURER 2.00 X X 0 0 0 DR JOSEPH MATTSON FORMER WHLC REPRESENTATIVE 2.00 X 0 0 0 ROBERT DROWN WHLC REPRESENTATIVE 0.00 X 0 0 0 JIM LONG ADMINISTRATOR/CEO 6.00 X 0 162251 20490 NATHAN STADHEIM CFO 8.00 X 0 88149 18361 0 250400 38851 0 0 1 0 PRIME TIME HEALTHCARE LLC PO BOX 3544 OMAHA NE 681030544 PROVIDE LOCUM NURSING STAFF 122061 US FOODS PO BOX 14489 GRAND FORKS ND 582084489 PROVIDE FOOD AND DIETARY SUPPLIES 114863 2 45799 12676 58475 RESIDENT SERVICE REVEN 623000 3578810 3578810 ASSISTED LIVING REVENU 623000 437748 437748 MISCELLANEOUS REVENUE 900099 17768 17768 4034326 4092801 4016558 0 17768 2281882 2146399 135483 50093 44926 5167 331130 315791 15339 161315 151793 9522 52879 52879 2615 2615 28802 28802 168388 166362 2026 5528 5528 7833 7833 22341 22341 249407 236056 13351 17483 11825 5658 12842 12842 149193 149193 30030 21181 8849 SUPPLIES- MEDICAL & OTH 285193 282396 2797 MAINTENANCE 41949 41949 EQUIPMENT 39447 36839 2608 STAFF RECRUITMENT 21740 21412 328 15734 2452 13282 3975824 3641416 334408 0 59310 223108 459585 380601 16455 20083 5981 11774 2215805 1375163 870432 840642 1411763 1476208 329419 339672 589157 524121 20347 23639 152535 152052 1509505 1508947 2600963 2548431 X -1189200 -1072223 -1189200 -1072223 1411763 1476208 116977 0 X X 0 1 X 1 0 X 1677 34243 2179 88766 59696 186561 3564539 3943022 3826515 3913771 4034326 19282173 3666 14515 19022 2356 39559 3569882 3991780 3847716 4004893 4094022 19508293 0 0 0 19508293 15 15 15 15 3569897 3991780 3847716 4004893 4094022 19508308 1.00000 1.00000 0.00000 0.00000 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 1 X 122647 122647 1379912 865752 514160 573806 462089 111717 139440 47322 92118 840642 DUE TO RELATED PARTY 308947 NOTE PAYABLE TO WEST RIVER HEALTH SERVICES FOUNDATION 600000 NOTE PAYABLE TO WEST RIVER HEALTH SERVICES 600000 1508947 X 4092801 0 4092801 0 4092801 3975824 0 3975824 0 3975824 PART IV, LINE 2B: WESTERN HORIZONS LIVING CENTERS ACT AS CUSTODIAN FOR THE FUNDS OF THE NURSING FACILITY RESIDENTS AND HOLDS SECURITY DEPOSITS FOR RESIDENTS OF THE ASSISTED LIVING FACILITIES. THESE FUNDS ARE INCLUDED IN CASH AND ACCOUNTS PAYABLE IN THE FINANCIAL STATEMENTS. RESIDENT TRUST FUNDS AND SECURITY DEPOSITS TOTALED $23,639 AND $20,347 AT MARCH 31, 2015 AND 2014. PART X, LINE 2: WESTERN HORIZONS LIVING CENTERS (WHLC) IS ORGANIZED AS A NORTH DAKOTA NONPROFIT AND HAS BEEN RECOGNIZED BY THE INTERNAL REVENUE SERVICE (IRS) AS EXEMPT FROM FEDERAL INCOME TAXES UNDER INTERNAL REVENUE CODE SECTION 501(C)(3). WHLC IS ANNUALLY REQUIRED TO FILE A RETURN OF ORGANIZATION EXEMPT FROM INCOME TAX (FORM 990) WITH THE IRS. IN ADDITION, WHLC IS SUBJECT TO INCOME TAX ON NET INCOME THAT IS DERIVED FROM BUSINESS ACTIVITIES THAT ARE UNRELATED TO ITS EXEMPT PURPOSE. WHLC HAS DETERMINED IT IS NOT SUBJECT TO UNRELATED BUSINESS INCOME TAX AND HAS NOT FILED AN EXEMPT ORGANIZATION BUSINESS INCOME TAX RETURN (FORM 99T) WITH THE IRS. WHLC 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. WHLC 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. 0 0 0 0 0 0 0 0 0 JIM LONG ADMINISTRATOR/CEO 0 162251 0 0 0 0 0 8096 0 12394 0 182741 0 0 PART I, LINE 3 THE CEO COMPENSATION IS PAID AND DETERMINED BY A RELATED ORGANIZATION, WEST RIVER HEALTH SERVICES. THE COMPENSATION IS DETERMINED THROUGH THE USE OF: A COMPENSATION COMMITTEE CONSISTING OF THE EXECUTIVE COMMITTEE; COMPENSATION SURVEY OR STUDY; AND APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE. A CITY OF HETTINGER NORTH DAKOTA 456002094 2007-12-03 900000 PURCHASE OF NURSING HOME AND EQUIPMENT 0 0 0 A 375879 900000 900000 2007 1 0 1 1 A 0 0 0 0 0 0 0 A 0 0 1 0 1 0 0 0 0 A 0 FORM 990, PART VI, SECTION A, LINE 1 THE EXECUTIVE COMMITTEE CAN ACT FOR AND ON BEHALF OF THE FULL BOARD. IT IS COMPRISED OF THE CHAIR, VICE CHAIR, SECRETARY/TREASURER, PAST CHAIR, MEDICAL STAFF REPRESENTATIVE, AND ONE ADDITIONAL MEMBER OF THE WESTERN HORIZONS LIVING CENTER BOARD. FORM 990, PART VI, SECTION A, LINE 6 WESTER RIVER HEALTH SERVICES FOUNDATION IS THE SOLE MEMBER. FORM 990, PART VI, SECTION A, LINE 7A AS THE SOLE MEMBER, WEST RIVER HEALTH SERVICES FOUNDATION ELECTS THE BOARD OF DIRECTORS. FORM 990, PART VI, SECTION A, LINE 7B THE FOLLOWING ACTIONS OF THE BOARD OF DIRECTORS REQUIRE APPROVAL BY THE WEST RIVER HEALTH SERVICES FOUNDATION: 1) CHANGES TO THE ARTICLES OF INCORPORATION OR BYLAWS; 2) DEBT IN EXCESS OF SET LIMITS; 3) DISSOLUTION OR MERGER OF THE CORPORATION; 4) SALE OR TRANSFER OF ANY CAPITAL ASSESTS WITH A PURCHASE PRICE OR FAIR MARKET VALUE GREATER THAN $100,000. FORM 990, PART VI, SECTION B, LINE 11 THE CFO AND CEO WILL REVIEW THE FORM 990 PRIOR TO THE COMPLETED FORM 990 BEING DISTRIBUTED ELECTRONICALLY TO THE BOARD MEMBERS FOR THEIR REVIEW AND COMMENTS. THE FORM 990 IS ALSO REVIEWED AND DISCUSSED AT A BOARD MEETING. FORM 990, PART VI, SECTION B, LINE 12C ALL MEDICAL STAFF, EMPLOYEES, AND BOARD MEMBERS ARE REQUIRED TO DISCLOSE ANY POTENTIAL CONFLICTS. POTENTIAL CONFLICTS ARE REVIEWED BY THE CEO. BOARD MEMBERS WITH CONFLICTS ABSTAIN FROM VOTING, AND THIS ACTION IS NOTED IN BOARD MINUTES. FORM 990, PART VI, SECTION B, LINE 15 EACH BOARD AND MEDICAL STAFF MEMBER ANNUALLY COMPLETES AN EVALUATION FORM ON THE ADMINISTRATOR'S PERFORMANCE; THE CHAIRMAN OF THE EXECUTIVE COMMITTEE TABULATES THE RESULTS AND REVIEWS WITH THE MEMBERS OF THE EXECUTIVE COMMITTEE; RESULTS ARE PRESENTED TO THE FULL BOARD OF DIRECTORS WHO HAVE FINAL AUTHORITY IN DETERMINING COMPENSATION. COMPARABILITY DATA FROM THE ND LONG TERM CARE ASSOCIATION, AS WELL AS OTHER COMPARATIVE INDUSTRY INFORMATION, IS USED IN DETERMINING COMPENSATION. COMPENSATION PAID TO THE CEO & CFO IS PAID AND DETERMINED BY A RELATED ORGANIZATION, WEST RIVER HEALTH SERVICES (WRHS). THE COMPENSATION PROCEDUTRES USED BY WRHS ARE AS FOLLOWS: CEO: EACH BOARD AND MEDICAL STAFF MEMBER ANNUALLY COMPLETES AN EVALUATION FROM ON THE CEO'S PERFORMANCE; THE CHAIRMAN OF THE EXECUTIVE COMMITTEE TABULATES THE RESULTS AND REVIEWS WITHT HE MEMBERS OF THE EXECUTIVE COMMITTEE; RESULTS ARE PRESENTED TO THE FULL BOARD OF DIRECTORS WHO HAVE FINAL AUTHORITY IN DETERMINING COMPENSATION. COMPARABILITY DATA FROM THE STATE HOSPITAL ASSOCIATION, AS WELL AS OTHER COMPARATIVE INDUSTRY INFORMATION, IS USED IN DETERMINING COMPENSATION. CFO: THE CEO REVIEWS THE CFO PERFORMANCE AND USES COMPARABILITY DATA IN DETERMINING COMPENSATION. ALL OTHER EMPLOYEES: ADMINISTRATIVE STAFF USE COMPARABILITY DATA IN SETTING COMPESATION FOR EACH LEVEL OF EMPLOYEE. THESE PROCESSES WERE LAST REVIEWED IN APRIL OF 2012. 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 XII, LINE 2C: THE BOARD OF DIRECTORS IS RESPONSIBLE FOR THE OVERSIGHT OF THE AUDIT. THIS PROCESS HAS NOT CHANGED FROM PREVIOUS YEARS. WEST RIVER HEALTH SERVICES 1000 HWY 12 HETTINGER ND 58639 450340688 HOSPITAL ND 501C3 LINE 3 WEST RIVER HEALTH SERVICES FOUNDATION 0 WEST RIVER HEALTH SERVICES FOUNDATION 1000 HWY 12 HETTINGER ND 58639 450411825 FUNDRAISING ND 501C3 LINE 11C, III-FI 0 0 0 1 0 1 0 0 0 0 0 1 0 0 0 0 1 0 0 0 WEST RIVER HEALTH SERVICES FOUNDATION C 45799 CASH PAID WEST RIVER HEALTH SERVICES E 600000 CASH PAID WEST RIVER HEALTH SERVICES FOUNDATION E 600000 CASH PAID WEST RIVER HEALTH SERVICES P 102510 CASH PAID WEST RIVER HEALTH SERVICES K 92100 LEASE AGREEMENT