SOUTHWEST HEALTHCARE CORPORATION: Form 990, tax year 2012
View the entire original 990 at ProPublica ↗
- Organization
- SOUTHWEST HEALTHCARE CORPORATION (EIN 45-0458242)
- Tax period
- 2012-01-01 to 2012-12-31
- Filed
- 2013-11-15
- IRS object ID
- 201333199349308913
- Schema version
- 2012v2.1
- 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 K
- Schedule L
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Timestamp | 2013-11-15T15:25:03-06:00 | Timestamp |
| Tax Period End Date | 2012-12-31 | TaxPeriodEndDate |
Preparer Firm PreparerFirm
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 450250958 | EIN |
Preparer Firm Business Name PreparerFirmBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | EIDE BAILLY LLP | BusinessNameLine1 |
Preparer Firm US Address PreparerFirmUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO BOX 1914 | AddressLine1 |
| City | BISMARCK | City |
| State | ND | State |
| ZIP Code | 585021914 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnType |
| Tax Period Begin Date | 2012-01-01 | TaxPeriodBeginDate |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 450458242 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Southwest Healthcare Services | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Control | SOUT | NameControl |
| Phone | 7015233214 | Phone |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 802 2nd St NW | AddressLine1 |
| City | Bowman | City |
| State | ND | State |
| ZIP Code | 58623 | ZIPCode |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | Becky Hansen | Name |
| Title | CEO | Title |
| Phone | 7015233214 | Phone |
| Date Signed | 2013-11-15 | DateSigned |
| Authorize Third Party | 1 | AuthorizeThirdParty |
Preparer Preparer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | Lisa Chaffee CPA | Name |
| PTIN | P00193453 | PTIN |
| Phone | 7012551091 | Phone |
| Date Prepared | 2013-11-15 | DatePrepared |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax Year | 2012 | TaxYear |
| Build TS | 2016-03-07 17:11:31Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Principal Officer Person | Becky Hansen | NameOfPrincipalOfficerPerson |
Address Principal Officer US AddressPrincipalOfficerUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 802 2nd St NW | AddressLine1 |
| City | Bowman | City |
| State | ND | State |
| ZIP Code | 58623 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | 13704208 | GrossReceipts |
| Group Return For Affiliates | 0 | GroupReturnForAffiliates |
| Organization501c3 | X | Organization501c3 |
| Web Site | www.swhealthcare.net | WebSite |
| Type Of Organization Corporation | X | TypeOfOrganizationCorporation |
| Year Formation | 2000 | YearFormation |
| State Legal Domicile | ND | StateLegalDomicile |
| Activity Or Mission Description | Southwest Healthcare Services is organized to provide quality health care services. | ActivityOrMissionDescription |
| Nbr Voting Members Governing Body | 9 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 6 | NbrIndependentVotingMembers |
| Total Nbr Employees | 246 | TotalNbrEmployees |
| Total Nbr Volunteers | 55 | TotalNbrVolunteers |
| Total Gross UBI | 0 | TotalGrossUBI |
| Net Unrelated Business Txbl Income | 0 | NetUnrelatedBusinessTxblIncome |
| Contributions Grants Prior Year | 938214 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 793530 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 10803296 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 11785434 | ProgramServiceRevenueCY |
| Investment Income Prior Year | 37117 | InvestmentIncomePriorYear |
| Investment Income Current Year | 19655 | InvestmentIncomeCurrentYear |
| Other Revenue Prior Year | 4662 | OtherRevenuePriorYear |
| Other Revenue Current Year | 7520 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 11783289 | TotalRevenuePriorYear |
| Total Revenue Current Year | 12606139 | TotalRevenueCurrentYear |
| Grants And Similar Amnts Prior Year | 17076 | GrantsAndSimilarAmntsPriorYear |
| Grants And Similar Amnts CY | 0 | GrantsAndSimilarAmntsCY |
| Benefits Paid To Members Prior Year | 0 | BenefitsPaidToMembersPriorYear |
| Benefits Paid To Members CY | 0 | BenefitsPaidToMembersCY |
| Salaries Etc Prior Year | 6881252 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 7544925 | SalariesEtcCurrentYear |
| Total Prof Fundrsng Exp Prior Year | 0 | TotalProfFundrsngExpPriorYear |
| Total Prof Fundrsng Exp CY | 0 | TotalProfFundrsngExpCY |
| Total Fundrsng Exp Current Year | 0 | TotalFundrsngExpCurrentYear |
| Other Expense Prior Year | 5156956 | OtherExpensePriorYear |
| Other Expenses Current Year | 5206333 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 12055284 | TotalExpensesPriorYear |
| Total Expenses Current Year | 12751258 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | -271995 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | -145119 | RevenuesLessExpensesCY |
| Total Assets BOY | 9976633 | TotalAssetsBOY |
| Total Assets EOY | 10170738 | TotalAssetsEOY |
| Total Liabilities BOY | 4578868 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 4882664 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | 5397765 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 5288074 | NetAssetsOrFundBalancesEOY |
| Info In Schedule O Part III | X | InfoInScheduleOPartIII |
| Mission Description | 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. | MissionDescription |
| Significant New Program Services | 0 | SignificantNewProgramServices |
| Significant Change | 0 | SignificantChange |
| Expense | 11068961 | Expense |
| Revenue | 11785434 | Revenue |
| Description | Southwest Healthcare Services (Southwest) consists of a 23-bed acute care hospital, 59-bed nursing facility, 14-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, wellness center 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 amount of charges foregone based on established rates was $40,102 for the year ended December 31, 2012. 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: free sports physicals for students, health fairs, and skin cancer screenings. | Description |
| Total Program Service Expense | 11068961 | TotalProgramServiceExpense |
| Described In501 C3 | 1 | DescribedIn501C3 |
| Schedule B Required | 1 | ScheduleBRequired |
| Political Activities | 0 | PoliticalActivities |
| Lobbying Activities | 0 | LobbyingActivities |
| Subject To Proxy Tax | 0 | SubjectToProxyTax |
| Donor Advised Funds | 0 | DonorAdvisedFunds |
| Conservation Easements | 0 | ConservationEasements |
| Collections Of Art | 0 | CollectionsOfArt |
| Credit Counseling | 1 | CreditCounseling |
| Term Or Permanent Endowments | 1 | TermOrPermanentEndowments |
| Report Land Bldg Equip | 1 | ReportLandBldgEquip |
| Report Invest Oth Securities | 0 | ReportInvestOthSecurities |
| Report Prog Rel Invest | 0 | ReportProgRelInvest |
| Report Other Assets | 0 | ReportOtherAssets |
| Report Other Liabilities | 1 | ReportOtherLiabilities |
| Report Fin48 Footnote | 1 | ReportFin48Footnote |
| Independent Audit Financial Stmt | 1 | IndependentAuditFinancialStmt |
| Consolidated Audit Financial Stmt | 0 | ConsolidatedAuditFinancialStmt |
| School | 0 | School |
| Foreign Office | 0 | ForeignOffice |
| Foreign Activities | 0 | ForeignActivities |
| More Than5000 K To Organizations | 0 | MoreThan5000KToOrganizations |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividuals |
| Professional Fundraising | 0 | ProfessionalFundraising |
| Fundraising Activities | 1 | FundraisingActivities |
| Gaming | 0 | Gaming |
| Hospital | 1 | Hospital |
| Financial Stmt Attached | 1 | FinancialStmtAttached |
| Grants To Organizations | 0 | GrantsToOrganizations |
| Grants To Individuals | 0 | GrantsToIndividuals |
| Schedule J Required | 1 | ScheduleJRequired |
| Tax Exempt Bonds | 1 | TaxExemptBonds |
| Invest Tax Exempt Bonds | 0 | InvestTaxExemptBonds |
| Escrow Account | 0 | EscrowAccount |
| On Behalf Of Issuer | 0 | OnBehalfOfIssuer |
| Excess Benefit Transaction | 0 | ExcessBenefitTransaction |
| Prior Excess Benefit Transaction | 0 | PriorExcessBenefitTransaction |
| Loan To Officer Or DQP | 0 | LoanToOfficerOrDQP |
| Grant To Related Person | 0 | GrantToRelatedPerson |
| Bsnss Rltnshp With Organization | 0 | BsnssRltnshpWithOrganization |
| Bsnss Rltnshp Thru Family Member | 1 | BsnssRltnshpThruFamilyMember |
| Officer Entity With Bsnss Rltnshp | 0 | OfficerEntityWithBsnssRltnshp |
| Deductible Non Cash Contributions | 0 | DeductibleNonCashContributions |
| Deductible Contributions Of Art | 0 | DeductibleContributionsOfArt |
| Terminated | 0 | Terminated |
| Partial Liquidation | 0 | PartialLiquidation |
| Disregarded Entity | 1 | DisregardedEntity |
| Related Entity | 0 | RelatedEntity |
| Related Org Controlled Entity | 0 | RelatedOrgControlledEntity |
| Transfers To Exempt Non Chrtbl Org | 0 | TransfersToExemptNonChrtblOrg |
| Activities Conducted Partnership | 0 | ActivitiesConductedPartnership |
| Schedule O Required | 1 | ScheduleORequired |
| Number Forms Transmitted With1096 | 19 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Compliance With Backup Witholding | 1 | ComplianceWithBackupWitholding |
| Number Of Employees | 246 | NumberOfEmployees |
| Employment Tax Returns Filed | 1 | EmploymentTaxReturnsFiled |
| Unrelated Business Income | 0 | UnrelatedBusinessIncome |
| Foreign Financial Account | 0 | ForeignFinancialAccount |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTrans |
| Taxable Party Notification | 0 | TaxablePartyNotification |
| Non Deductible Contributions | 0 | NonDeductibleContributions |
| Quid Pro Quo Contributions | 1 | QuidProQuoContributions |
| Quid Pro Quo Disclosure | 1 | QuidProQuoDisclosure |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOf |
| Funds To Pay Premiums | 0 | FundsToPayPremiums |
| Premiums Paid | 0 | PremiumsPaid |
| Indoor Tanning Services | 0 | IndoorTanningServices |
| Info In Schedule O Part VI | X | InfoInScheduleOPartVI |
| Nbr Voting Governing Body Members | 9 | NbrVotingGoverningBodyMembers |
| Number Independent Voting Members | 6 | NumberIndependentVotingMembers |
| Family Or Business Relationship | 0 | FamilyOrBusinessRelationship |
| Delegation Of Management Duties | 0 | DelegationOfManagementDuties |
| Changes To Organizing Docs | 0 | ChangesToOrganizingDocs |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuse |
| Members Or Stockholders | 0 | MembersOrStockholders |
| Election Of Board Members | 0 | ElectionOfBoardMembers |
| Decisions Subject To Approval | 0 | DecisionsSubjectToApproval |
| Minutes Of Governing Body | 1 | MinutesOfGoverningBody |
| Minutes Of Committees | 0 | MinutesOfCommittees |
| Officer Mailing Address | 0 | OfficerMailingAddress |
| Local Chapters | 0 | LocalChapters |
| Form990 Provided To Governing Body | 1 | Form990ProvidedToGoverningBody |
| Conflict Of Interest Policy | 1 | ConflictOfInterestPolicy |
| Annual Disclosure Covered Persons | 1 | AnnualDisclosureCoveredPersons |
| Regular Monitoring Enforcement | 1 | RegularMonitoringEnforcement |
| Whistleblower Policy | 1 | WhistleblowerPolicy |
| Document Retention Policy | 1 | DocumentRetentionPolicy |
| Compensation Process CEO | 1 | CompensationProcessCEO |
| Compensation Process Other | 1 | CompensationProcessOther |
| Investment In Joint Venture | 0 | InvestmentInJointVenture |
| Upon Request | X | UponRequest |
The Books Are In Care Of TheBooksAreInCareOf
Name Business NameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Sasha Ruggles CFO | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Telephone Number | 7015233214 | TelephoneNumber |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 802 2nd St NW | AddressLine1 |
| City | Bowman | City |
| State | ND | State |
| ZIP Code | 58623 | ZIPCode |
Form990 Part VII Section A Form990PartVIISectionA (16 entries)
| TitleTitle | Average Hours Per WeekAverageHoursPerWeek | Individual Trustee Or DirectorIndividualTrusteeOrDirector | OfficerOfficer | Reportable Comp From OrganizationReportableCompFromOrganization | Reportable Comp From Related OrgsReportableCompFromRelatedOrgs | Other CompensationOtherCompensation | Highest Compensated EmployeeHighestCompensatedEmployee |
|---|---|---|---|---|---|---|---|
| Steve Wild | |||||||
| President | 1.00 | X | X | 0 | 0 | 0 | |
| Connie Krinke | |||||||
| Vice President | 1.00 | X | X | 0 | 0 | 0 | |
| Dan Swanson | |||||||
| Secretary | 1.00 | X | X | 0 | 0 | 0 | |
| Justin Wolbaum | |||||||
| Trustee | 1.00 | X | 0 | 0 | 0 | ||
| Lynn Peterson | |||||||
| Trustee | 1.00 | X | 0 | 0 | 0 | ||
| Gary Brennan | |||||||
| Trustee | 1.00 | X | 0 | 0 | 0 | ||
| Galen Strand | |||||||
| Trustee | 1.00 | X | 0 | 0 | 0 | ||
| Jean Tennant | |||||||
| Trustee | 1.00 | X | 0 | 0 | 0 | ||
| Jackie Lambourn | |||||||
| Trustee | 1.00 | X | 0 | 0 | 0 | ||
| Dennis Goebel | |||||||
| CEO-through July 2012 | 40.00 | X | 84121 | 0 | 491 | ||
| Becky Hansen | |||||||
| CEO/CFO | 40.00 | X | 112180 | 0 | 19559 | ||
| Sasha Ruggles | |||||||
| CFO | 40.00 | X | 52543 | 0 | 2790 | ||
| Dr David Meadows | |||||||
| Physician | 40.00 | 208040 | 0 | 0 | X | ||
| Dr Forrest Lanchbury | |||||||
| Physician | 40.00 | 270865 | 0 | 20212 | X | ||
| Christine Peterson | |||||||
| Nurse Practitioner | 43.00 | 119010 | 0 | 0 | X | ||
| Dr Sherryl Tomboulian | |||||||
| Physician | 40.00 | 208055 | 0 | 20212 | X | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 1054814 | TotalReportableCompFromOrg |
| Total Reportable Comp Frm Rltd Orgs | 0 | TotalReportableCompFrmRltdOrgs |
| Total Other Compensation | 63264 | TotalOtherCompensation |
| Number Individuals GT100 K | 5 | NumberIndividualsGT100K |
| Formers Listed | 0 | FormersListed |
| Total Comp GT150 K | 1 | TotalCompGT150K |
| Compensation From Other Sources | 0 | CompensationFromOtherSources |
Contractor Compensation ContractorCompensation (2 entries)
| Address Line1AddressOfContractor/AddressUS/AddressLine1 | CityAddressOfContractor/AddressUS/City | StateAddressOfContractor/AddressUS/State | ZIP CodeAddressOfContractor/AddressUS/ZIPCode | Description Of ServicesDescriptionOfServices | CompensationCompensation |
|---|---|---|---|---|---|
| Dakota Travel Nurse | |||||
| 502 West Main St | Mandan | ND | 58554 | Contract nursing | 550317 |
| Northern Plains Laboratory | |||||
| 3502 Franklin Ave | Bismarck | ND | 58502 | Lab purchased services | 106201 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Contractors GT100 K | 2 | NumberOfContractorsGT100K |
| Fundraising Events | 18860 | FundraisingEvents |
| Government Grants | 421141 | GovernmentGrants |
| All Other Contributions | 353529 | AllOtherContributions |
| Total Contributions | 793530 | TotalContributions |
Program Service Revenue ProgramServiceRevenue (2 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome |
|---|---|---|---|
| Patient & Resident Service Revenu | 622110 | 11715186 | 11715186 |
| Supporting revenue | 900099 | 70248 | 70248 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | 11785434 | TotalProgramServiceRevenue |
Investment Income InvestmentIncome
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 18544 | TotalRevenueColumn |
| Exclusion | $18,544 | ExclusionAmount |
Gross Amount Sales Assets GrossAmountSalesAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 1091269 | Securities |
Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 1089406 | Securities |
| Other | 752 | Other |
Gain Or Loss GainOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 1863 | Securities |
| Other | -752 | Other |
Net Gain Or Loss Investments NetGainOrLossInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 1111 | TotalRevenueColumn |
| Exclusion | $1,111 | ExclusionAmount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Income Fundraising Events | 15431 | GrossIncomeFundraisingEvents |
| Cntrbtns Rprtd Fundraising Events | 18860 | CntrbtnsRprtdFundraisingEvents |
| Fundraising Direct Expenses | 7911 | FundraisingDirectExpenses |
Net Income From Fundraising Events NetIncomeFromFundraisingEvents
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 7520 | TotalRevenueColumn |
| Exclusion | $7,520 | ExclusionAmount |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 12606139 | TotalRevenueColumn |
| Related Or Exempt Function Income | 11785434 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 0 | UnrelatedBusinessRevenue |
| Exclusion | $27,175 | ExclusionAmount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part IX | X | InfoInScheduleOPartIX |
Comp Current Officers Directors CompCurrentOfficersDirectors
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 282484 | Total |
| Management And General | 282484 | ManagementAndGeneral |
Comp Disqual Persons CompDisqualPersons
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 110100 | Total |
| Program Services | 110100 | ProgramServices |
Other Salaries And Wages OtherSalariesAndWages
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 6113849 | Total |
| Program Services | 5657127 | ProgramServices |
| Management And General | 456722 | ManagementAndGeneral |
Other Employee Benefits OtherEmployeeBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 575854 | Total |
| Program Services | 480576 | ProgramServices |
| Management And General | 95278 | ManagementAndGeneral |
Payroll Taxes PayrollTaxes
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 462638 | Total |
| Program Services | 409053 | ProgramServices |
| Management And General | 53585 | ManagementAndGeneral |
Fees For Services Legal FeesForServicesLegal
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 5275 | Total |
| Management And General | 5275 | ManagementAndGeneral |
Fees For Services Accounting FeesForServicesAccounting
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 29056 | Total |
| Management And General | 29056 | ManagementAndGeneral |
Fees For Services Other FeesForServicesOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1731749 | Total |
| Program Services | 1490244 | ProgramServices |
| Management And General | 241505 | ManagementAndGeneral |
Advertising Advertising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 57955 | Total |
| Program Services | 60 | ProgramServices |
| Management And General | 57895 | ManagementAndGeneral |
Office Expenses OfficeExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 326799 | Total |
| Program Services | 168490 | ProgramServices |
| Management And General | 158309 | ManagementAndGeneral |
Information Technology InformationTechnology
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 160031 | Total |
| Management And General | 160031 | ManagementAndGeneral |
Occupancy Occupancy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 213894 | Total |
| Program Services | 212023 | ProgramServices |
| Management And General | 1871 | ManagementAndGeneral |
Travel Travel
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 106807 | Total |
| Program Services | 90546 | ProgramServices |
| Management And General | 16261 | ManagementAndGeneral |
Conferences Meetings ConferencesMeetings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1463 | Total |
| Management And General | 1463 | ManagementAndGeneral |
Interest Interest
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 168702 | Total |
| Program Services | 168702 | ProgramServices |
Depreciation Depletion DepreciationDepletion
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 928304 | Total |
| Program Services | 928304 | ProgramServices |
Insurance Insurance
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 93052 | Total |
| Management And General | 93052 | ManagementAndGeneral |
Other Expenses OtherExpenses (4 entries)
| DescriptionDescription | TotalTotal | Program ServicesProgramServices | Management And GeneralManagementAndGeneral |
|---|---|---|---|
| Medical Supplies | 738054 | 738054 | |
| Bad Debts | 374606 | 374606 | |
| Dietary Food and Supple | 225307 | 225307 | |
| Dues Licensing & Subscr | 41927 | 12417 | 29510 |
All Other Expenses AllOtherExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 3352 | Total |
| Program Services | 3352 | ProgramServices |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 12751258 | Total |
| Program Services | 11068961 | ProgramServices |
| Management And General | 1682297 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Savings And Temp Cash Investments SavingsAndTempCashInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 82103 | BOY |
| EOY | 133642 | EOY |
Pledges And Grants Receivable PledgesAndGrantsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 22885 | BOY |
| EOY | 2510 | EOY |
Accounts Receivable AccountsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2306490 | BOY |
| EOY | 2532088 | EOY |
Inventories For Sale Or Use InventoriesForSaleOrUse
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 152712 | BOY |
| EOY | 178565 | EOY |
Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 51799 | BOY |
| EOY | 78813 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Buildings Equipment Basis | 16585686 | LandBuildingsEquipmentBasis |
| Land Bldg Equipment Accum Deprec | 11787169 | LandBldgEquipmentAccumDeprec |
Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 4991366 | BOY |
| EOY | 4798517 | EOY |
Investments Pub Traded Securities InvestmentsPubTradedSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1651027 | BOY |
| EOY | 1772926 | EOY |
Investments Other Securities InvestmentsOtherSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 26576 | BOY |
| EOY | 28835 | EOY |
Intangible Assets IntangibleAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 170408 | BOY |
| EOY | 167072 | EOY |
Other Assets Total OtherAssetsTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 521267 | BOY |
| EOY | 477770 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 9976633 | BOY |
| EOY | 10170738 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1507316 | BOY |
| EOY | 1387639 | EOY |
Deferred Revenue DeferredRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 79113 | BOY |
| EOY | 75874 | EOY |
Tax Exempt Bond Liabilities TaxExemptBondLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2990000 | BOY |
| EOY | 2740000 | EOY |
Escrow Account Liability EscrowAccountLiability
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2439 | BOY |
| EOY | 3261 | EOY |
Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | 180779 | EOY |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 495111 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 4578868 | BOY |
| EOY | 4882664 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Unrestricted Net Assets UnrestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 4892521 | BOY |
| EOY | 4750019 | EOY |
Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 378132 | BOY |
| EOY | 410943 | EOY |
Permanently Restricted Net Assets PermanentlyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 127112 | BOY |
| EOY | 127112 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 5397765 | BOY |
| EOY | 5288074 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 9976633 | BOY |
| EOY | 10170738 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | X | InfoInScheduleOPartXI |
| Reconcilation Revenue Expenses | -145119 | ReconcilationRevenueExpenses |
| Reconciliation Unrealized Invest | 66096 | ReconciliationUnrealizedInvest |
| Reconcilation Other Changes | -30668 | ReconcilationOtherChanges |
| Method Of Accounting Accrual | X | MethodOfAccountingAccrual |
| Accountant Compile Or Review | 0 | AccountantCompileOrReview |
| FS Audited | 1 | FSAudited |
FS Audited Basis FSAuditedBasis
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Statement Separate | X | FinancialStatementSeparate |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | 0 | AuditCommittee |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequired |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital170b1 Aiii | X | Hospital170b1Aiii |
Schedule B IRS990ScheduleB
Contributor Info ContributorInfo
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor Number | RESTRICTED | ContributorNumber |
Contributor Name Business ContributorNameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor Address US ContributorAddressUS
| 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) |
|---|---|---|
| Aggregate Contributions | RESTRICTED | AggregateContributions |
Schedule D IRS990ScheduleD
| Field | Value | IRS element (for citing) |
|---|---|---|
| Agent Trustee Etc | 1 | AgentTrusteeEtc |
| Beginning Balance | 10607 | BeginningBalance |
| Additions During Year | 7479 | AdditionsDuringYear |
| Distributions During Year | 3352 | DistributionsDuringYear |
| Ending Balance | 14734 | EndingBalance |
| Included On FS | 1 | IncludedOnFS |
| Explanation In Part XIII | X | ExplanationInPartXIII |
Current Year CurrentYear
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Of Year Balance | 115112 | BeginningOfYearBalance |
| Investment Earnings Or Losses | 6976 | InvestmentEarningsOrLosses |
| Other Expenditures | 6976 | OtherExpenditures |
| End Of Year Balance | 115112 | EndOfYearBalance |
Current Year Minus1 Year CurrentYearMinus1Year
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Of Year Balance | 115112 | BeginningOfYearBalance |
| Contributions | 219 | Contributions |
| Investment Earnings Or Losses | -219 | InvestmentEarningsOrLosses |
| End Of Year Balance | 115112 | EndOfYearBalance |
Current Year Minus2 Years CurrentYearMinus2Years
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Of Year Balance | 115112 | BeginningOfYearBalance |
| Investment Earnings Or Losses | 5502 | InvestmentEarningsOrLosses |
| Other Expenditures | 5502 | OtherExpenditures |
| End Of Year Balance | 115112 | EndOfYearBalance |
Current Year Minus3 Years CurrentYearMinus3Years
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Of Year Balance | 115112 | BeginningOfYearBalance |
| Investment Earnings Or Losses | 10913 | InvestmentEarningsOrLosses |
| Other Expenditures | 10913 | OtherExpenditures |
| End Of Year Balance | 115112 | EndOfYearBalance |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Permanent Endowment EOY Balance | 1.00000 | PermanentEndowmentEOYBalance |
| Endowments Held By Unrelated Orgs | 0 | EndowmentsHeldByUnrelatedOrgs |
| Endowments Held By Related Orgs | 0 | EndowmentsHeldByRelatedOrgs |
Land Land
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 75488 | OtherCostOrOtherBasis |
| Book Value | 75488 | BookValue |
Buildings Buildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 8975862 | OtherCostOrOtherBasis |
| Depreciation | 6368615 | Depreciation |
| Book Value | 2607247 | BookValue |
Equipment Equipment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 6691733 | OtherCostOrOtherBasis |
| Depreciation | 5144396 | Depreciation |
| Book Value | 1547337 | BookValue |
Other Land Buildings OtherLandBuildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 842603 | OtherCostOrOtherBasis |
| Depreciation | 274158 | Depreciation |
| Book Value | 568445 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Land Buildings | 4798517 | TotalOfBookValueLandBuildings |
Other Liabilities OtherLiabilities (2 entries)
| DescriptionDescription | AmountAmount |
|---|---|
| Estimated third-party payor settlements | $125,700 |
| Construction and retainage payable | $369,411 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Amounts | 495111 | TotalOfAmounts |
| Footnote In Part XIII | X | FootnoteInPartXIII |
| Tot Revenue Etc Audited Fincl Stmt | 12161808 | TotRevenueEtcAuditedFinclStmt |
| Other Revenues | -374606 | OtherRevenues |
| Revenue Not Rptd F990 | -374606 | RevenueNotRptdF990 |
| Revenue Subtotal | 12536414 | RevenueSubtotal |
| Other Revenues Not Included | 69725 | OtherRevenuesNotIncluded |
| Revenue Not Rptd On Fin Stmt | 69725 | RevenueNotRptdOnFinStmt |
| Total Revenue Per Form990 | 12606139 | TotalRevenuePerForm990 |
| Tot Expenses Etc Audited Fincl Stmt | 12381211 | TotExpensesEtcAuditedFinclStmt |
| Other Expenses Included | 7911 | OtherExpensesIncluded |
| Expenses Not Rptd F990 | 7911 | ExpensesNotRptdF990 |
| Expenses Subtotal | 12373300 | ExpensesSubtotal |
| Other Expenses Not Included | 377958 | OtherExpensesNotIncluded |
| Expenses Not Rptd On Fin Stmt | 377958 | ExpensesNotRptdOnFinStmt |
| Total Expenses Per Form990 | 12751258 | TotalExpensesPerForm990 |
Form990 Schedule D Part XIII Form990ScheduleDPartXIII (8 entries)
| Return ReferenceReturnReference | ExplanationExplanation | IdentifierIdentifier |
|---|---|---|
| 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 $3,261 at December 31, 2012. | |
| Part V, Line 4: | Endowments held and administered by Southwest Healthcare Services: The earnings from the $115,112 are for hospital operations, as necessary. The principal of $115,112 is permanently restricted. | Description of Intended Use of Endowment Funds: |
| Part X, Line 2: | Southwest is organized as a North Dakota nonprofit corporation and has been recognized by the Internal Revenue Service (IRS) as exempt from federal income taxes under Internal Revenue Code Section 501(c)(3). Southwest is annually required to file a Return of Organization Exempt from Income Tax (Form 990) with the IRS. In addition, Southwest is subject to income tax on net income that is derived from business activities that are unrelated to its exempt purpose. Southwest has determined it is not subject to unrelated business income tax and has not filed an Exempt Organization Business Income Tax Return (Form 990T) with the IRS. 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. | Description of Uncertain Tax Positions Under FIN 48: |
| Provision for bad debts included in expenses on Form 990 -374,606. | Part XI, Line 2d - Other Adjustments: | |
| Auxiliary revenue 7,479. Fundraising expenses reported in revenue on Form 990 -7,911. Contributions reported in fund balance on financial statements 70,157. | Part XI, Line 4b - Other Adjustments: | |
| Fundraising expenses reported in revenue on Form 990 7,911. | Part XII, Line 2d - Other Adjustments: | |
| Auxiliary expenses 3,352. Provision for bad debts included in expenses on Form 990 374,606. | Part XII, Line 4b - Other Adjustments: |
Schedule G IRS990ScheduleG
Events Information EventsInformation
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Event1 | Celebrity Waiter | NameOfEvent1 |
| Gross Receipts Event1 | 34291 | GrossReceiptsEvent1 |
| Charitable Contributions Event1 | 18860 | CharitableContributionsEvent1 |
| Gross Revenue Event1 | 15431 | GrossRevenueEvent1 |
| Rent Facility Costs Event1 | 450 | RentFacilityCostsEvent1 |
| Food And Beverage Event1 | 5035 | FoodAndBeverageEvent1 |
| Entertainment Event1 | 1500 | EntertainmentEvent1 |
| Other Direct Expenses Event1 | 926 | OtherDirectExpensesEvent1 |
| Gross Receipts Total | 34291 | GrossReceiptsTotal |
| Charitable Contributions Total | 18860 | CharitableContributionsTotal |
| Gross Revenue Total Events | 15431 | GrossRevenueTotalEvents |
| Rent Facility Costs Total Events | 450 | RentFacilityCostsTotalEvents |
| Food And Beverage Total Events | 5035 | FoodAndBeverageTotalEvents |
| Entertainment Total Events | 1500 | EntertainmentTotalEvents |
| Other Direct Expenses Total Events | 926 | OtherDirectExpensesTotalEvents |
| Direct Expense Summary Events | 7911 | DirectExpenseSummaryEvents |
| Net Income Summary | 7520 | NetIncomeSummary |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Charity Care Policy | 1 | CharityCarePolicy |
| Written Policy | 1 | WrittenPolicy |
| Policy Applied To All Hospitals | X | PolicyAppliedToAllHospitals |
| FPG Reference Free Care | 1 | FPGReferenceFreeCare |
| Pcent100 | X | Pcent100 |
| FPG Reference Discounted Care | 1 | FPGReferenceDiscountedCare |
Discounted Other DiscountedOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | X | Other |
| Discounted Other Percentage | 175.000000000000 | DiscountedOtherPercentage |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Free Disc Care Medically Indigent | 1 | FreeDiscCareMedicallyIndigent |
| Amounts Budgeted For Charity Care | 1 | AmountsBudgetedForCharityCare |
| Expenses Exceeded Budget | 0 | ExpensesExceededBudget |
| Annual Community Benefit Report | 0 | AnnualCommunityBenefitReport |
Charity Care At Cost CharityCareAtCost
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 34000 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 34000 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00270 | PercentOfTotalExpense |
Unreimbursed Medicaid UnreimbursedMedicaid
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 2483445 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 2474618 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 8827 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00070 | PercentOfTotalExpense |
Total Charity Care TotalCharityCare
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 2517445 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 2474618 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 42827 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00340 | PercentOfTotalExpense |
Community Health Services CommunityHealthServices
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 3300 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 3300 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00030 | PercentOfTotalExpense |
Subsidized Health Services SubsidizedHealthServices
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 2170579 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 1276710 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 893869 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.07220 | PercentOfTotalExpense |
Total Other Benefits TotalOtherBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 2173879 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 1276710 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 897169 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.07250 | PercentOfTotalExpense |
Total Community Benefits TotalCommunityBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 4691324 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 3751328 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 939996 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.07590 | PercentOfTotalExpense |
Health Improvement Advocacy HealthImprovementAdvocacy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Building Expense | 7884 | TotalCommunityBuildingExpense |
| Net Community Building Expense | 7884 | NetCommunityBuildingExpense |
| Percent Of Total Expense | 0.00060 | PercentOfTotalExpense |
Total Total
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Building Expense | 7884 | TotalCommunityBuildingExpense |
| Net Community Building Expense | 7884 | NetCommunityBuildingExpense |
| Percent Of Total Expense | 0.00060 | PercentOfTotalExpense |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | 0 | BadDebtExpenseReported |
| Bad Debt Expense | $374,606 | BadDebtExpenseAmount |
| Amount Attributable To | 74921 | AmountAttributableTo |
| Amount Reimbursed By Medicare | 2674805 | AmountReimbursedByMedicare |
| Cost Of Care Reimbursed By Medicare | 2675972 | CostOfCareReimbursedByMedicare |
| Medicare Surplus Or Shortfall | -1167 | MedicareSurplusOrShortfall |
Costing Methodology Used CostingMethodologyUsed
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | X | Other |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | 1 | WrittenDebtCollectionPolicy |
| Provision For Charity Care | 1 | ProvisionForCharityCare |
| Number Of Hospital Facilities | 1 | NumberOfHospitalFacilities |
Form990 Schedule H Part V Section A Form990ScheduleHPartVSectionA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility Number | 1 | FacilityNumber |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Southwest Healthcare Services | BusinessNameLine1 |
Address Address
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 14 6th Ave SW | AddressLine1 |
| City | Bowman | City |
| State | ND | State |
| ZIP Code | 58623 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Licensed Hospital | X | LicensedHospital |
| General Medical And Surgical | X | GeneralMedicalAndSurgical |
| Critical Access Hospital | X | CriticalAccessHospital |
| Er24 Hours | X | Er24Hours |
| Other | Rural Health Clinic | Other |
Form990 Schedule H Part V Section B Form990ScheduleHPartVSectionB
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Southwest Healthcare Services | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital Facility Number | 1 | HospitalFacilityNumber |
| CHNA Conducted | 0 | CHNAConducted |
| Eligibility Criteria Explained | 1 | EligibilityCriteriaExplained |
| Uses FPG Free | 1 | UsesFPGFree |
| FPG Free Percent | 100.000000000000 | FPGFreePercent |
| Uses FPG Discounted | 1 | UsesFPGDiscounted |
| FPG Discount Percent | 175.000000000000 | FPGDiscountPercent |
| Explains Basis | 1 | ExplainsBasis |
| Income Level | X | IncomeLevel |
| Asset Level | X | AssetLevel |
| Medical Indigency | X | MedicalIndigency |
| Explains Application Method | 1 | ExplainsApplicationMethod |
| Includes Publicity Measures | 1 | IncludesPublicityMeasures |
| Available On Request | X | AvailableOnRequest |
| Other Publicity | X | OtherPublicity |
| Actions On Nonpayment | 1 | ActionsOnNonpayment |
| Collection Activities | 0 | CollectionActivities |
| Notify Before Discharge | X | NotifyBeforeDischarge |
| Notified All Patients | X | NotifiedAllPatients |
| Documented Determination | X | DocumentedDetermination |
| Nondiscrim Emergency Care Policy | 1 | NondiscrimEmergencyCarePolicy |
| Used Other Method | X | UsedOtherMethod |
| Amounts Generally Billed | 1 | AmountsGenerallyBilled |
| Gross Charges | 0 | GrossCharges |
Form990 Schedule H Part V Section C Form990ScheduleHPartVSectionC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Other Facilities | 3 | NumberOfOtherFacilities |
Other Facilities OtherFacilities (3 entries)
| Address Line1Address/AddressLine1 | CityAddress/City | StateAddress/State | ZIP CodeAddress/ZIPCode | Facility TypeFacilityType |
|---|---|---|---|---|
| Southwest Healthcare Services | ||||
| 802 2nd ST NW | Bowman | ND | 58623 | Independent Living and LTC |
| Bowman Ambulance Services | ||||
| 606 1st ST SW | Bowman | ND | 58623 | Ambulance Services |
| Sunrise Village | ||||
| 203 11th AV NW | Bowman | ND | 58623 | Assisted Living and Home Care |
Form990 Schedule H Part VI Form990ScheduleHPartVI (13 entries)
| ExplanationExplanation | IdentifierIdentifier |
|---|---|
| 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. Unreimbursed Medicaid on line 7b was calculated using the costing methods to prepare the cost reports. Community health improvement services, line 7e, are reported based on actual expense amounts recorded from the events in the general ledger. The cost for subsidized health services reported on line 7g was determined using the Medicare Cost Report. | |
| Part I, L7 Col(f): The amount of bad debt expense removed from total expenses reported on Form 990 was $374,606. | |
| Part II: 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 4: Bad debt is reported as charges on the financial statements.Patient accounts are written off to bad debt after every effort is made to collect the balance and patients are given opportunities to complete charity care applications or set up payment plans. All discounts and contractual adjustments are applied to accounts before they are written off to bad debt. Payments on accounts are first applied to any current portion due and then applied to any amount previously written off to bad debt. If an account has no current portion due and has been written off to bad debt, any payments made would reduce bad debt expense.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 bad debt expense 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.The footnote to the Organization's financial statements can be found on page 9 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 2012 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: 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.The PFS Rep is also responsible for screening patients through the collection process for financial assistance. | |
| Part V, Section B, Line 14g: A summary of the financial assistance policy and financial assistance contact information can be found at the admissions desk in the hospital and clinic. It is also given to all self-pay patients. The financial assistance application can also be found on our website and is summarized on the back of our billing invoices. | Southwest Healthcare Services |
| Part V, Section B, Line 20d: The maximum amount charged to a patient under the financial assistance policy for emergency and medically necessary care is 75% of the gross charges. This is based on the lowest discount under the charity care policy of 25%. The hospital will review the proposed methods to determine amounts generally billed to determine its discount under the financial assistance policy meets the requirements of 501(r). | Southwest Healthcare Services |
| Part V, Section B, Line 21: The hospital provides a reduction to gross charges through the use of a sliding fee scale approach of 25%, 50%, 75, or up to 100% if the patient has no material applicable insurance, no material usable liquid assets or significant and/or catastrophic medical bills. The hospital has not determined the amount generally billed under the various proposed methods of calculation. Therefore, it is possible a patient under the financial assistance policy could have paid more than the amount generally billed. The hospital will review the various methods to determine amounts generally billed to ensure it is in compliance with Section 501(r). | Southwest Healthcare Services |
| Part VI, Line 2: The Organization is currently in process of completing a community health needs assessment. This was completed 3rd Quarter 2013. | |
| 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 and clinic. It is also given to all self-pay patients. 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. | |
| 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 5,500 people in rural counties of Bowman and Slope, North Dakota and Harding County in South Dakota. We have been very fortunate, in our service area, to have an unemployment rate at 2.3% with a median income of $40,764. In 2011, approximately 16% of the residents in our community were uninsured. Southwest Healthcare Services is the only hospital in our service area with no medically underserved areas. | |
| 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 also participates in the Vision West strategic planning process for our region and community and leads the healthcare focus group. |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Employment Contract | X | WrittenEmploymentContract |
| Compensation Survey | X | CompensationSurvey |
| Board Or Committee Approval | X | BoardOrCommitteeApproval |
| Severance Payment | 0 | SeverancePayment |
| Supplemental Nonqual Retire Plan | 0 | SupplementalNonqualRetirePlan |
| Equity Based Comp Arrangement | 0 | EquityBasedCompArrangement |
| Comp Based On Revenue Of Filing Org | 0 | CompBasedOnRevenueOfFilingOrg |
| Comp Based On Revenue Related Orgs | 0 | CompBasedOnRevenueRelatedOrgs |
| Comp Based Net Earnings Filing Org | 0 | CompBasedNetEarningsFilingOrg |
| Comp Based Net Earnings Relate Orgs | 0 | CompBasedNetEarningsRelateOrgs |
| Any Non Fixed Payments | 0 | AnyNonFixedPayments |
| Initial Contract Exception | 0 | InitialContractException |
Form990 Schedule J Part II Form990ScheduleJPartII (3 entries)
| TitleTitle | Base Compensation Filing OrgBaseCompensationFilingOrg | Comp Based On Related OrgsCompBasedOnRelatedOrgs | Bonus Filing OrgBonusFilingOrg | Bonus Related OrgsBonusRelatedOrgs | Other Compensation Filing OrgOtherCompensationFilingOrg | Other Compensation Related OrgsOtherCompensationRelatedOrgs | Deferred Comp Filing OrgDeferredCompFilingOrg | Deferred Comp Related OrgsDeferredCompRelatedOrgs | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrg | Nontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgs | Total Compensation Filing OrgTotalCompensationFilingOrg | Total Compensation Related OrgsTotalCompensationRelatedOrgs | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrg | Comp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Dr David Meadows | ||||||||||||||
| Physician | 208040 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 208040 | 0 | 0 | 0 |
| Dr Forrest Lanchbury | ||||||||||||||
| Physician | 209139 | 0 | 61726 | 0 | 0 | 0 | 0 | 0 | 20212 | 0 | 291077 | 0 | 0 | 0 |
| Dr Sherryl Tomboulian | ||||||||||||||
| Physician | 208055 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 20212 | 0 | 228267 | 0 | 0 | 0 |
Schedule K IRS990ScheduleK
Form990 Schedule K Part I Form990ScheduleKPartI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
Issuer Name IssuerName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | City of Bowman North Dakota | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Issuer EIN | 456002040 | IssuerEIN |
| CUSIP Number | 10302TAL4 | CUSIPNumber |
| Date Issued | 2006-08-03 | DateIssued |
| Issue Price | 3902372 | IssuePrice |
| Description Of Purpose | Adv refund Rev Bonds issued 6/1/99, long-term financing for a bldg project | DescriptionOfPurpose |
| Defeased | 0 | Defeased |
| On Behalf Of Issuer | 0 | OnBehalfOfIssuer |
| Pool Financing | 0 | PoolFinancing |
Form990 Schedule K Part II Form990ScheduleKPartII
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Amount Retired | 1165000 | AmountRetired |
| Total Proceeds | 3902372 | TotalProceeds |
| Issuance Costs From Proceeds | 78100 | IssuanceCostsFromProceeds |
| Capital Expenditures | 1482072 | CapitalExpenditures |
| Other Spent Proceeds | 2342200 | OtherSpentProceeds |
| Year Of Subst Completion | 2010 | YearOfSubstCompletion |
| Current Refunding | 0 | CurrentRefunding |
| Advance Refunding | 1 | AdvanceRefunding |
| Final Allocation Made | 1 | FinalAllocationMade |
| Adequate Books And Recds Maintaind | 1 | AdequateBooksAndRecdsMaintaind |
Form990 Schedule K Part III Form990ScheduleKPartIII
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Owning Bond Financed Property | 0 | OwningBondFinancedProperty |
| Any Lease Arrangements | 0 | AnyLeaseArrangements |
| Mngment Cntrct Bond Financd Prprty | 0 | MngmentCntrctBondFinancdPrprty |
| Any Research Agreements | 0 | AnyResearchAgreements |
| Prcntge Prvt Business Use By Others | 0.00000 | PrcntgePrvtBusinessUseByOthers |
| Percentage Of Prvt Business Re UBI | 0.00000 | PercentageOfPrvtBusinessReUBI |
| Total Private Business Use | 0.00000 | TotalPrivateBusinessUse |
| Bond Iss Meet Prvt Security Pay Test | 0 | BondIssMeetPrvtSecurityPayTest |
| Change In Use Bond Financed Prop | 0 | ChangeInUseBondFinancedProp |
| Non Qualified Bond Remed Procdrs | 0 | NonQualifiedBondRemedProcdrs |
Form990 Schedule K Part IV Form990ScheduleKPartIV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Form8038 T Filed | 0 | Form8038TFiled |
| Rebate Not Due Yet | 0 | RebateNotDueYet |
| Exception To Rebate | 0 | ExceptionToRebate |
| No Rebate Due | 1 | NoRebateDue |
| Variable Rate Issue | 0 | VariableRateIssue |
| Hedge Identified In Books And Recds | 0 | HedgeIdentifiedInBooksAndRecds |
| Gross Proceeds Invested In GIC | 0 | GrossProceedsInvestedInGIC |
| Gross Proceeds Invested | 0 | GrossProceedsInvested |
| Written Proc To Monitor Reqs | 0 | WrittenProcToMonitorReqs |
Form990 Schedule K Part V Form990ScheduleKPartV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Proc To Undertk Corrective Action | 0 | ProcToUndertkCorrectiveAction |
Form990 Schedule K Part VI Form990ScheduleKPartVI (3 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| Schedule K Part IV, Arbitrage, Line 2c | Date Rebate Computation Performed | Issuer Name: City of Bowman, North Dakota Date the Rebate Computation was Performed: 06/01/2011 |
| Schedule K, Part II, Line 11: | The amount reported on Part II, line 11 is the amount of bond proceeds used to refund the prior bonds issued in 1999. | |
| Schedule K: | Southwest Healthcare Services does not have a written policy for post compliance but works closely with their auditors on requirements. They review their debt service requirements and validate insurance annually. |
Schedule L IRS990ScheduleL
Form990 Schedule L Part IV Form990ScheduleLPartIV (3 entries)
| RelationshipRelationship | Amount Of TransactionAmountOfTransaction | Description Of TransactionDescriptionOfTransaction | Sharing Of RevenuesSharingOfRevenues |
|---|---|---|---|
| Rochelle Thompson | |||
| Rochelle is the daughter of board member Galen Strand | 37496 | Compensation | 0 |
| Sarah Wolbaum | |||
| Sarah is the wife of board member Justin Wolbaum | 34619 | Compensation | 0 |
| Jennifer Wild | |||
| Jennifer is the wife of board member Steve Wild | 37985 | Compensation | 0 |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (8 entries)
| Return ReferenceReturnReference | ExplanationExplanation | IdentifierIdentifier |
|---|---|---|
| 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 8b | The Organization has an Executive Committee, however it did not meet during 2012. | |
| Form 990, Part VI, Section B, line 11 | The return is reviewed initially by the CEO, CFO, and Accountant. The return is then emailed to the Board of Directors 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 398,117. Management and general expenses 43,141. Fundraising expenses 0. Total expenses 441,258. Purchased services and recruitment: Program service expenses 325,598. Management and general expenses 66,379. Fundraising expenses 0. Total expenses 391,977. Professional fees and consulting: Program service expenses 766,529. Management and general expenses 131,985. Fundraising expenses 0. Total expenses 898,514. | Other Fees |
| Form 990, Part XI, line 9: | Unrestricted net assets released from restriction 9,000. Temporarily restricted net assets released from restrictions -35,541. Auxiliary net income -4,127. | Changes in Net Assets or Fund Balances: |
Schedule R IRS990ScheduleR
Form990 Schedule R Part I Form990ScheduleRPartI
Name Of Disregarded Entity NameOfDisregardedEntity
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Southwest Healthcare Auxiliary | BusinessNameLine1 |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 802 2nd St NW | AddressLine1 |
| City | Bowman | City |
| State | ND | State |
| ZIP Code | 58623 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 450458242 | EIN |
| Primary Activities | Charitable events to help raise funds for the SWHC facility | PrimaryActivities |
| Legal Domicile State | ND | LegalDomicileState |
| Total Income | 7479 | TotalIncome |
| EOY Assets | 14734 | EOYAssets |
Direct Controlling Entity Name DirectControllingEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Southwest Healthcare Services | BusinessNameLine1 |
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