2011-02-09T09:00:03-06:00 2010-03-31 EIDE BAILLY LLP 4310 17TH AVE S PO BOX 2545 FARGO ND 581082545 990 2009-04-01 450340688 West River Health Services WEST 7015674561 1000 Highway 12 Hettinger ND 58639 Jim K Long 7015674561 2011-02-08 1 LISA CHAFFEE CPA 7012398500 2011-02-08 2009 2016-02-24 21:20:13Z West River Regional Medical Center Jim K Long 1000 Highway 12 Hettinger ND 58639 23446580 0 X www.wrhs.com X 1950 ND Provide comprehensive health and wellness services to the residents and visitors of the region. 10 10 319 5 0 0 516158 153711 21432862 23117323 114214 110627 56061 57239 22119295 23438900 3412 4100 0 9461508 10103759 0 96297 12151578 13162422 21616498 23270281 502797 168619 22951503 23965813 6980306 7686536 15971197 16279277 The mission of West River Health Services (WRHS) is to provide comprehensive health and wellness services to the residents and visitors of the region. 0 0 21928970 4100 23140212 West River Health Services (WRHS) is a nationally-recognized rural health care delivery system including hospital, swing bed, surgery, lab, radiology, emergency room, seven clinics, eye clinic, visiting nurse services, ambulance service, family therapy, rehabilitative therapies including physical therapy, occupational therapy and speech therapy, home medical equipment store, and wellness/fitness services. In FY 2010, WRHS provided acute care services to 982 patients for a total of 3,703 days of care. Swing bed services were provided to 149 patients for a total of 1,077 days of care. In addition, 691 days of observation care were provided. There were 1,733 emergency room visits during the year. Ninety-eight babies were born during the year with a total of 239 days of care provided. There were a total of 999 surgical cases during the year, with 802 of those being done on an outpatient basis. The ambulance crew made 290 ambulance runs/transfers throughout the year. There were 44,838 clinic encounters to the seven clinics. Ancillary services were provided as follows: 205,080 lab tests; 12,776 radiology tests; 8,284 respiratory therapy tests; 41,559 meals to patients, visitors, and employees; and 12,013 therapy visits. Throughout the year, there were 1,802 RHC nurse visits. It is the policy of the WRHS to provide quality health care services to all patients in the region regardless of race, color, creed or ability to pay. To this end, WRHS offers free and discounted services to patients who lack ability to pay. The WRHS Charity Care Policy, initially approved in June of 2006 and revised in 2007, assures that all eligible patients will receive the care they deserve without financial worry. The Finance Committee of the Board of Directors has oversight of the Charity Care Program, approves eligibility criteria, and evaluates program effectiveness. The amount of charity care provided in FY '10 for eligible individuals was $183,120. These amounts reflect the amount of charges foregone based on established rates.In addition to total uncompensated care for FY '10 of $942,447, WRHS also provides many other services as in-kind support to benefit the health of the communities and region it serves. These community benefits include conducting health screenings at all area farm and home shows, offering CPR and first aid programs to the general public, organizing/conducting an annual Fun Run & Walk during the 4th of July celebration, providing free educational pamphlets and brochures on various health topics to the general public, guiding tours of the hospital/clinic to area school children, providing health and wellness education classes to the public, assisting seniors/elderly to enroll and take part in medication assistance programs, educating/training paramedics/EMTs in all outreach communities, maintaining a health resource library for the general public, sending The Reporter (to inform on health-related issues and to update on educational meetings) quarterly to 12,000 households, and maintaining a fitness center for the public. 21928970 1 1 0 0 0 0 0 0 0 1 0 1 0 0 0 0 0 0 0 0 1 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 41 0 1 319 1 0 0 0 0 0 0 0 0 0 10 10 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 X Karan Ehlers 7015676150 1000 Highway 12 Hettinger ND 58639 Travis Ellison 2.00 X 220 0 0 Cody Jorgenson 2.00 X 260 0 0 Lance Ketterling 2.00 X 260 0 0 Eric Andress 2.00 X 60 0 0 Gary Dewhirst 2.00 X 250 0 0 Larry Jackson 2.00 X 60 0 0 Doug Jerde 2.00 X 140 0 0 Robert Parker 2.00 X 210 0 0 Cleve Teske 2.00 X 20 0 0 Dale Wegh 2.00 X 50 0 0 Dr John Joyce 2.00 X 0 0 0 Mike Clayton 2.00 X X 140 0 0 Arloween Remington 2.00 X X 180 0 0 Linda Weaver Braaten 2.00 X X 170 0 0 Karan Ehlers 28.00 X 74733 0 21891 Jim Long 34.00 X 143114 0 16487 Susan Hallen 40.00 X 138944 0 11031 Mitch Schultz 40.00 X 102740 0 15041 461551 0 64450 3 0 1 1 United Clinics Physician PC 1100 Highway 12 Hettinger ND 58639 Physician Services 4091518 Dr Mark Kristy 1000 Highway 12 Hettinger ND 58639 Radiology Services 408456 Capital City Construction PO Box 7337 Bismarck ND 58507 Construction 257668 Mondak Imaging Services 11 South 7th St Suite 241 Miles City MT 59301 MRI Services 244639 Robert Gibb & Sons Inc PO Box 10188 Fargo ND 58106 Mechanical Contractor 147535 7 2336 24220 127155 153711 Patient Service Revenu 621110 22305009 22305009 Affiliation Support 900099 300000 300000 Assisted Living Rent 900099 106860 106860 Cafeteria 722210 81769 81769 Insurance Proceeds 900099 59459 59459 264226 264226 23117323 110627 110627 60050 6911 53139 53139 22889 30250 4869 2336 769 4100 4100 23438900 23140212 0 144977 4100 4100 261905 261905 7688969 7188563 428842 71564 272227 254761 14930 2536 1312355 1203605 96768 11982 568303 515469 47702 5132 3861 3861 48367 48367 5937209 5845391 91818 93070 93070 3679958 3593934 86024 527408 526007 1401 187579 143385 44194 3861 2687 1174 235955 235955 1148171 1148171 65354 57680 7674 Bad Debts 905468 905468 Recruitment 168646 128699 39947 Dues and Subscriptions 64034 41200 22834 Employee Activities Exp 23036 23036 Lost Charge Expense 6079 6079 64366 34746 24537 5083 23270281 21928970 1245014 96297 1779789 2632000 4147196 3596592 493727 500007 155820 208794 28140058 14514857 13601046 13625201 1602142 1916000 1171783 1487219 22951503 23965813 1943505 1947573 1000 4485272 5254170 250123 179405 300406 305388 6980306 7686536 X 15971197 16279277 15971197 16279277 22951503 23965813 X 0 1 1 X 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 1 5579 17636 15707 7508 18000 90113 108113 1713121 15164505 6631349 10246277 30107 9440465 7599198 1871374 1683747 284310 1399437 13625201 Deferred financing costs 103384 Related Party Receivables 1383835 1487219 Due to Related Party 305388 305388 23438900 23270281 168619 147302 -7841 139461 308080 23509551 147302 -66695 80607 23428944 9956 9956 23438900 23195559 7680 7680 23187879 82402 82402 23270281 Part IV, Line 1b: The hospital has an auxiliary that operates under their EIN. These funds are controlled by the auxiliary board members. Part X: Description of Uncertain Tax Positions Under FIN 48: The Foundation, WRHS, and WHLC are organized as North Dakota nonprofit corporations and have been recognized by the Internal Revenue Service as exempt from federal income taxes under Internal Revenue Code Section 501(c)(3). The Company undergoes an annual analysis of its various tax positions; assessing the likelihood of these positions being upheld upon examination with relevant tax authorities, as defined by the accounting principles generally accepted in the United States of America. The Company believes that it is compliant with all IRS tax regulations and as of March 31, 2010 has not recorded a tax liability for a tax uncertainty. Part XI, Line 8 - Other Adjustments: Auxiliary net income change: -7841. Part XII, Line 2d - Other Adjustments: Rental Property Depreciation Included in Revenue on Financial Statements: -66695. Part XII, Line 4b - Other Adjustments: Special Events Expense: -769. Auxiliary revenue: 17636. Rental expenses: -6911. Part XIII, Line 2d - Other Adjustments: Special Events Expense: 769. Rental Property Expenses : 6911. Part XIII, Line 4b - Other Adjustments: Auxiliary expenses: 15707. Rental Property Depreciation Included in Revenue on Financial Statements: 66695. 1 1 X 1 X 1 X 1 1 1 0 0 112891 112891 0.00510 685399 573929 111470 0.00500 20197 32762 -12565 0.00000 818487 606691 211796 0.01010 46875 21466 25409 0.00110 39800 39800 0.00180 86675 21466 65209 0.00290 905162 628157 277005 0.01300 5502 5502 0.00020 2250 2250 0.00010 2433 1000 1433 0.00010 10185 1000 9185 0.00040 0 558209 172040 10044748 10394803 -350055 X 1 1 West River Health Services

1000 Highway 12 Hettinger ND 58639

X X X X New England Clinic

820 2nd Avenue West Bowman ND 58647

Certified Clinic Bowman Clinic

608 Hwy 12 West Bowman ND 58623

Certified Clinic Scranton Clinic

211 Main Street Scranton ND 58653

Certified Clinic Mott Clinic

420 Pacific Avenue Mott ND 58646

Certified Clinic Lemmon Clinic

401 6th Avenue West Lemmon SD 57638

Certified Clinic Part I, Line 7: The organization used Worksheet 2 to determine the cost for Part III, Line 7, Rows a through c. The organization used actual expenses to determine the cost for Part I, Line 7, Rows e and f. Part I, Line 7f: The amount of bad debt included on Form 990, Part IX, line 25, column (A), but subtracted for purposes of calculating the percentage on this line is $905,468. Part III, Line 4: Footnote to organization's financial statements that describes bad debt expense:The carrying amount of patient and resident receivables is reduced by a valuation allowance that reflects management's estimate of amounts that will not be collected from patients, residents, and third-party payors. Management reviews patient and resident receivables by payor class and applies percentages to determine estimated amounts that will not be collected from third parties under contractual agreements and amounts that will not be collected from patients and residents due to bad debts. Management considers historical write off and recovery information in determining the estimated bad debt provision.Bad debt expense was converted to cost using the cost to charge ratio calculated using Worksheet 2.The estimated amount of the organization's bad debt expense that is attributable to patients eligible under the organization's charity care policy is approximately $172,040. This is an estimation of the bad debts that would be eligible for the charity care policy if the patients applied. Part III, Line 8: The full amount of Medicare shortfall should be regarded as community benefit.West River Health Service's mission is to provide care to anyone regardless of their ability to pay. As such, they provide services to Medicare patients even though they know in many cases they will not recover their full margin on this work. Providing services under the Medicare program regardless of making an operating margin increases access to healthcare services, which is a community benefit.Medicare allowable costs of care are based on the Medicare cost report. The Medicare cost report is completed based on the rules and regulations set forth by CMS. Part III, Line 9b: WRHS has established a written policy for the billing, collection and support for patients with payment obligations. WRHS makes every effort to adhere to the policy and is committed to applying the policy for assisting patients with limited means in a professional, consistent manner. WRHS educates staff members who work closely with patients (including those working in patient registration and admitting, financial assistance, customer service, billing and collections) on the policies with an emphasis on treating all patients with dignity and respect regardless of their insurance status or their ability to pay for services. The Financial Counselor is given more in-depth training on handling financial assistance requests, processing of applications, and managing outcomes. Part V: Part VI, Line 1: In relation to Part V, WRHS also has one podiatry center located in Dickinson, ND that is not required to be licensed under the state law. Because it does not have this requirement it was excluded from Part V Facility Information. Part I, Line 7e - Community Health Improvement Services and Community Benefit Operations: Fitness Center: Description of Activity: This is a fitness center located offsite from the main campus. Access to the center is by card key membership which is open to anyone within community and surrounding communities. The center is staffed approximately 24 hours/week; however, the therapy services inhabit space in the same building and are available Monday through Friday during normal work hours to supervise and/or maintain fitness center equipment in good working order. The center is equipped with several pieces of fitness equipment (recumbant bikes, tread mills, etc.). Currently,there are approximately 100 active memberships. Need for Activity: It has been determined through organized community group meetings that a need for a fitness center exists within the community. WRHS has had representation to those community meetings and volunteered to subsidize this activity as part of its mission to provide health and wellness services to the communities it serves. The fitness center has been in existence since 2005; however, over the years, the center has expanded its operations to include several new equipment pieces in effort to meet the needs of the community group. Physical and occupational therapy staff are also very closely involved and advise/monitor exercise programs for patients who have been through a therapy program. Objectives: Improve access to fitness and exercise programs, provide fitness and exercise programs at a nominal membership fee, address state and national initiatives on obesity and other health priorities, advance education and knowledge to the general public on importance of exercise and fitness in personal health.Total Community Benefit Expense $15,147Direct Offsetting Revenue $8,047Net Community Benefit Expense $7,100 Free Health-Related Brochures to Public: Description of Activity: Informational brochures on specific illnesses and diseases are provided to patients both in the hospital and clinic settings. These brochures contain up-to-date and vital information for patient on how to manage a disease/illness as has been determined by physician. Need for Activity: Need and desire for more information has been expressed by patients on return of patient satisfaction surveys. Objectives: Improve access to specific health-related information for patients, advance education and knowledge to the general public. Total Community Benefit Expense $2,423Net Community Benefit Expense $2,423 Medical Library: Description of Activity: Although a very small medical facility, WRHS has long subsidized the maintenance of a medical library available to staff, medical staff, and the general public. The library contains modern medical journals and periodicals as well as Consult and MDLearn software programs on two computers available for public use. The library is used extensively not only by medical staff but also by medical students and high school students as they prepare for science fair projects for medically-related research projects. The library is open 24x7 and is staffed for 24 hours/week. Need for Activity: There has been a long history of collabarative effort between the Hettinger Public School and WRHS. The School has encouraged its students to use the medical library and to work with professional staff as they do their research and/or consider careers in the medical field. Objectives: Improve access to the public on health-related information, advance education and knowledge to high school level students as they do research and plan for careers in the medical field, encourage collaborative efforts between the local school and medical professionals.Total Community Benefit Expense $4,015 (this is cost of periodicals/software calculated at 50% public use; all staff costs are also excluded)Net Community Benefit Expense $4,015 Medication Assistance: Description of Activity: The medication assistance program is a program subsidized by the hospital for the benefit of the general public. Began several years under the auspices of a federal grant, this program is designed to assist any and all individuals with enrollment in Medicare Part D as well as to work hand in hand with interested patients in obtaining medications and other pharmaceuticals from drug companies at reduced rates. Eligible patients must meet specified income guidelines to apply for and be deemed eligible for the reduction. There is a charge of $30 per quarter for those on the program. However, this cost does not fully cover the costs of program administration. There are approximately 60 individuals taking part in this program currently. Need for Activity: This need originated largely as part of a statewide endeavor to place community resource coodinators into each community across the state. Assessment surveys conducted at that time found a great need for this service in the rural areas of the state. Medicare Part D enrollment and continuance in the program can be very confusing for the elderly and the need to assist is evident. Objectives: Assist elderly population in Medicare Part D enrollment, provide assistance to eligible population in applying for and obtaining medications and other pharmaceuticals at a discount from retail, provide education and/or assistance in enrollment to other financial assistance programs.Total Community Benefit Expense $16,600Direct Offsetting Revenue $8,419Net Community Benefit Expense $8,181 General Screening/Flu Injection Administration: Description of Activity: One of the most attended events in the rural communities served by WRHS are the annual Farm and Home Shows. These Shows are held in three communities each fall--Hettinger, Lemmon, and Bowman. WRHS sends 3-5 staff to man booths at each Show. This staff will answer general health questions for the public, take free blood pressures, and administer flu vaccine to those interested. There is a charge of $20 for those receiving flu vaccine and/or WRHS will offer to submit a claim to insurance if the patient is interested. Approximately 250 people took advantage of the flu vaccine administration for this report period. Need for Activity: The need for flu vaccine and administration thereof is a public and national initiative to improve patient health and prevent spread of serious and contagious flu strains. The need for this activity has been widely proclaimed. The public has expressed appreciation for having this available on an annual basis. Objectives: A healthier community through administration and disease prevention, provide education on adverse effects if not immunized, prevent contagion of flu within the immediate and surrounding communities.Total Community Benefit Expense $7,285Direct Offsetting Revenue $5,000Net Community Benefit Expense $2,285 Standby Ambulance Services: Description of Activity: The local ambulance service provides a standby ambulance and two EMS staff at all Hettinger football games, rodeos, and demolition derbies. In addition, they are on call for all high school basketball, wrestling, and volleyball matches in case of emergency injuries. In this reporting period, there were ten events at which standby ambulance was made available. These services are provided free of charge to the community. Need for Activity: School officials and the community recognize the risk associated with any contact sport, espeically that of football, rodeo or derbies. It has been the longstanding tradition of WRHS to provide these services without charge to these not-for-profit entities. Objectives: Provide emergency and trauma care to participants of area sports, support local sports activities with encouragement toward safety.Total Community Benefit Expense $1,125Net Community Beneft Expense $1,1254th Of July Parade: Description of Activity: WRHS provided bottles of water for the parade.Total Community Benefit Expense $280Net Community Beneft Expense $280 Part VI, Line 2: There is representation from across the multi-county region on the WRHS board of directors; board members routinely provide feedback to administration and board of directors of the perceived health care needs within their respective communities.Board members and medical staff are brought together at the annual board retreat, at which time health care needs are discussed and become part of the strategic long-range planning process. This discussion will serve as the basis for health care strategic and action planning to develop health policies, allocate resources, improve or expand existing services, implement new programs and collaborate with other community health care providers. Although all members of the 14-member physician group with whom WRHS contracts for professional medical services reside in Hettinger, they travel daily/weekly to community clinics within the region. They have become advocates for each of these communities and represent community needs to administration and board of directorsWhile it has been several years since the last formal community needs assessment, WRHS is scheduled to conduct its next needs assessment in early 2011. Intent then is to continue this assessment every three years.WRHS conducts regular satisfaction surveys with patients who have received hospital/clinic services with WRHS. As part of that survey, patients are asked for their input for improvement and/or suggest other needed services.WRHS identifies unmet community health needs by participating in community coalitions, partnerships, boards, committees, advisory groups, and panels. Based on the above-noted assessment measures, the major community needs identified for 2009 were the need to increase access to quality health care, especially for children, pregnant women, and uninsured adults and seniors; the need to obtain medical care for the underserved by enrolling eligible residents in Medicaid, SCHIP, and other insurance programs and by building a better system of care for the uninsured; and the need to provide health education, disease prevention and chronic disease management (including obesity) programs to improve the health status of the communities served. Part VI, Line 3: It is the mission of WRHS to provide comprehensive health and wellness services to all residents and visitors in the region it serves. These services are offered to all patients regardless of race, color, creed or ability to pay. We are committed to provide quality health care services with compassion and respect, particularly the underinsured and uninsured population. It is the policy of WRHS to provide effective communications with patients regarding hospital bills, to make affirmative efforts to help patients apply for public and private financial support programs, to offer financial support to patients with limited means, to assist low-income patients in a consistent manner, and to maintain fair and consistent billing and collection practices for all patients with patient payment obligations. It is at the point of admission that ability to pay is assessed. Patients who are uninsured and believed to have limited resources are referred to the WRHS Financial Counselor who will determine the patient's eligibility for charity care and/or other financial assistance programs. The Financial Counselor will also discuss with the patient the availability of various governmental programs, including Medicaid or other state-funded programs. Where appropriate, the Financial Counselor will assist the patient with qualification and/or application to such programs. Several years ago, WRHS implemented the Good Neighbor Program. This is a program designed to provide financial assistance to underinsured eligible patients throughout the region. Funding for the Program was through a public fundraising campaign. Those funds, along with an annual sustainability contribution by WRHS, have allowed this Program to continue yet today. It is promoted via brochures, newspaper, and the WRHS website. In addition to this Program, patients unable to pay their medical bills are invited to submit an application to the charity care program. Both the Financial Counselor and the Patient Financial Services Manager are readily available to visit with candidates to this program and to assist in the application process, as appropriate. WRHS informs patients of its financial assistance programs through the WRHS website, brochures available at points of admission and in the Patient Care Handbook located in each patient room. Every effort is made to determine a patient's eligibility prior to or at the time of admission or service. However, determination for financial support can be made during any stage of the patient's stay after stabilization or collection cycle. Part VI, Line 4: Hettinger is located in rural southwestern North Dakota and borders the states of South Dakota and Montana. The City has a population of 1,307 with a total population of 2,593 in Adams County. In addition to the hospital and clinic services located in Hettinger, there are also rural clinics located in New England (Slope County), Bowman and Scranton (Bowman County), and Mott (Hettinger County), all in southwestern North Dakota. Another clinic is located in Lemmon, South Dakota (Perkins County). In total, West River Health Services provides health care to approximately 37,000 people over a 25,000 square mile inclusive of the counties named. The average household income for these counties is $27,935, which is considerably below the North Dakota average of $34,604. Twenty-two percent of the population in all counties served is 65 years of age or older. Four hundred twenty eight families within the service area fall below the federal poverty guidelines for an average of 12.28%. The North Dakota average for families falling below poverty levels is 8.3%. Not included to the above demographics is the City of Dickinson, 75 miles from Hettinger and located in Stark County. It is here that WRHS operates a weekly Foot and Ankle Center. With the exception of Dickinson, all other sites have been designated as medically underserved areas. Health care is an important part of the economy and, as such, the hospital and clinics have become one of the top employers in the region. Approximately 3.4% of all patients served are Medicaid recipients and 5.5% of all patients served are uninsured. There is another hospital and clinic in Bowman, located 40 miles west of Hettinger. There is also a hospital and several other clinics in Dickinson, located 75 northwest of Hettinger. Tertiary referral centers are located 150 miles away in Bismarck, North Dakota, and 180 miles away in Rapid City, South Dakota. Part VI, Line 5: West River Health Services is a not-for-profit organization whose mission is to provide comprehensive health and wellness services to residents and visitors of the region. We do this by reinvesting our profits back into the communities through various programs and services; making sure that care is available to everyone regardless of ability to pay; offering care with compassion to all patients; and providing a wide range of special benefits to each community, such as programs to manage care for persons with chronic diseases, health education and disease prevention initiatives, outreach for the elderly, and care for person who are poor or uninsured.Part II - Community Building ActivitiesLine 6 - Coalition BuildingSeveral of the WRHS staff are members of the Adams County Disaster Management Team and, as such, are also represented on the Southwest Region Coalition for Disaster Management. They also are actively involved in statewide initiatives to assure that WRHS and its partners are prepared in event of natural or manmade disasters. The flood of 2009 was a prime example of their involvement as they helped to develop procedures and protocol to follow in this natural disaster event. Included to the representation from WRHS are two representatives of the Quality Assurance/Quality Improvement Staff and the Disaster Management Coordinator for WRHS. In this reporting period, the following costs were realized for this community building effort.* Three staff met for 6 consecutive months of discussion/collaborative efforts with the Adams County Emergency Operations Center staff. Direct costs for this period were $688; indirect costs were $172. Total was $860.* Three staff met in regular monthly meetings over the year with the Southwest Region Disaster Management Team. Their goal was to develop a collaborative effort for disaster management that could be served throughout the region, to develop protocol for disaster management, and to educate other providers with disaster management protocol and guidelines. Direct costs for this period were $2,063; indirect costs were $516. Total was $2,579.* Three staff met for a period of six weeks (2 times a week) in teleconferences with the Statewide Disaster Management Team. Here they offered input to statewide disaster management protocol and took part in several table and field drills as preparation for natural or manmade disasters. Direct costs for this period were $1,650; indirect costs were $413. Total was $2,063.Grand total of this coalition-building effort is $5,502. There was no direct offsetting revenue to this project. The coalition efforts still continue today.Line 7 - Community Health Improvement AdvocacyHettinger has a locally-owned radio station. This station has a program called TTO (This, That, and Other Things). This program airs daily; WRHS has a designated hour per month to share information about the facility and promote general health and well-being. There have been six such programs over the past year in which staff went on TTO to inform of importance of flu vaccination, precautions for dealing with flu and other diseases, and other disease-specific cautions. Direct costs for staff to prepare and participate in the talk show were $1,800; indirect costs were $450. Total was $2,250.Line 8 - Workforce DevelopmentUnlike many parts of the State or across the nation, Hettinger and its community clinic sites are facing a burdensome manpower shortage. Because we must compete with oil field development and an industry that is paying much higher wages, we often compete for the same labor force. WRHS is an advocate of education and, particularly, of efforts for "growing" a clientele that will hopefully return to the area for permanent jobs at sometime in the future. In this past year, WRHS was the organizer as well as a participator in a SCRUBS camp for area schools. Several area communities participated in the one-day event and offered students a perspective on health careers and assistance available to them if they chose to forward their education in a medical field. This was a very successful event and well over 300 students were in attendance. Twelve staff from WRHS attended the camp and manned booths to answer questions and give specific information on careers in the health field. Direct costs for staff to participate were $1,946; indirect costs were $487. Total was $2,433. $1,000 of these costs were offset by a regional grant for advancement of health care careers. Part VI, Line 6: West River Health Services works with many community programs each year, often partnering with other organizations throughout the service area. The organization was instrumental in the application to and award of a Southwestern Area Healthcare Education Consortium, an outreach effort encompassing the western half of North Dakota. The goal of the SWAHEC is to assist health care providers in their recruitment and retention of health care workers. Quite the contrast to other parts of the nation, North Dakota is facing severe shortage of workers in many industries, including health care. Members from our management team stay connected to the communities through their involvement with other community organizations, including membership on numerous community boards and committees. Doing so gives the organization a voice and input into local activities, as well as serves as representation of health activities into each of the communities. West River Health Services has a policy of using any of its surplus funds for improvements that promote a higher level of quality patient care. The organization has long been a promoter of medical education and has enjoyed a longstanding relationship with the University of North Dakota School of Medicine in providing rotation sites for medical students. Physicians within the organization graciously preceptor these students. The board represents members from the community that are neither employees, nor contractors of the organization, nor family members thereof. WRHS extends medical staff privileges to all qualified physicians in its community for all of its departments. For more information about WRHS, visit www.wrhs.com. Part VI, Line 7: Part VI, Line 8: None X X X 0 0 0 0 0 0 0 0 0 Jim Long 143114 0 0 0 0 0 10293 0 7524 0 160931 0 0 0 Supplemental Information Part III Dr John Joyce is paid by United Clinic Physicians, an unrelated organization. Compensation information was unavailable from them for purposes of this return. City of Hettinger North Dakota 456002094 2008-01-31 5275000 Expand & renovate hospital/Hettinger Clinic & acquisition of fixed eqpt. 0 0 5275000 105500 5169500 2010 0 0 1 1 0 0 0 0 0 0.00000 0.00000 0.00000 1 0 1 0 0 0 0 Form 990, Part VI, Section A, line 6 West River Health Services Foundation is the sole member of the organization. West River Health Services board members are appointed by West River Health Services Foundation. Form 990, Part VI, Section A, line 7a As the sole member, The WRHS Foundation appoints the board members of WRHS. Form 990, Part VI, Section A, line 7b As sole member, WRHS Foundation approves all amendments to the Articles of Incorporation and Bylaws, approves debt when it excess levels set by the board of directors of the Foundation, approves dissolution or merger of the organization and approves the sale or transfer of any capital assets having a purchase price or 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 and reviewed by board members at their regular 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. Individuals with conflicts abstain from voting, and this action is noted in the board minutes. Form 990, Part VI, Section B, line 15 CEO: Each board and medical staff member annually complete an evaluation form on the CEO's performance. The Chairman of Executive Committee tabulates the results and reviews them with the other members of the Executive Committee. The 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's performance and uses comparability data in determining compensation. All other employees: The administrative staff use comparable data in setting compensation for each level of employee. Compensation was last reviewed in April of 2009. Form 990, Part VI, Section C, line 19 Administrative representatives of the organization will provide the governing board documents, conflict of interest policy, and financial statements upon written or verbal request to administrative representatives of the organization. Form 990, Part VII: In addition to the hours served at West River Health Services, Karan Ehlers serves an additional 10 hours at Western Horizons Living Center (WHLC) and 2 hours at the West River Health Services Foundation (WRHSF); Jim Long serves an additional 4 hours at WHLC and 2 hours at WRHSF. Dr John Joyce's compensation is paid by United Clinic Physicians. Compensation information was unavailable from them for purposes of this return. Western Horizons Living Centers 1104 Highway 12 Hettinger ND 58369 260794602 Long-term care/assisted living services ND 501(c)(3) 9 West River Health Services Foundation West River Health Services Foundation 1000 Highway 12 Hettinger ND 58639 450411825 Fundraising ND 501(c)(3) 11a N/A 0 0 1 0 0 0 0 0 1 0 0 0 1 1 0 1 0 0