2011-11-15T12:54:56-06:00 2010-12-31 EIDE BAILLY LLP PO BOX 1914 BISMARCK ND 58502 990 2010-01-01 450458242 SOUTHWEST HEALTHCARE SERVICES SOUT 7015235265 802 2ND ST NW BOWMAN ND 58623 DENNIS GOEBEL 7015235265 2011-11-15 1 LISA CHAFFEE CPA 7012551091 2011-11-11 2010 2016-03-07 17:11:31Z DENNIS GOEBEL 802 2ND ST NW BOWMAN ND 58623 11888040 0 X WWW.SWHEALTHCARE.NET X 2000 ND SOUTHWEST HEALTHCARE SERVICES IS ORGANIZED TO PROVIDE QUALITY HEALTH CARE SERVICES. 9 9 231 58 0 0 966962 735108 9711125 10957115 60579 45685 0 -601 10738666 11737307 13200 0 0 0 6011554 6394451 0 0 2715 4087631 4849974 10112385 11244425 626281 492882 9551745 10166151 4331006 4440776 5220739 5725375 X GUIDED BY FAITH-BASED LEADERSHIP, WE ARE A FAMILY OF SPECIALISTS, EACH PERFORMING A UNIQUE SERVICE. WITH A SPIRIT OF COMPASSION, WE PROVIDE EXCELLENCE IN HEALTHCARE TO THOSE WE ARE PRIVILEGED TO SERVE. 0 0 9878131 10957115 SOUTHWEST HEALTHCARE SERVICES (SOUTHWEST) CONSISTS OF A 23-BED ACUTE CARE HOSPITAL, 66-BED NURSING FACILITY, 16-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 $38,096 FOR THE YEAR ENDED DECEMBER 31, 2010.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. 9878131 1 1 0 0 0 0 0 1 1 1 0 0 0 0 1 1 0 0 0 0 0 0 0 0 0 1 0 0 1 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 1 28 0 1 231 1 0 0 0 0 0 0 0 0 0 0 X 9 9 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 X BECKY HANSEN CFO 7015233214 802 2ND ST NW BOWMAN ND 58623 SANDI TIVIS 1.00 X X 0 0 0 STEVE WILD 1.00 X X 0 0 0 ROSIE HILTON 1.00 X X 0 0 0 SUE JUNTUNEN 1.00 X 0 0 0 LYNN PETERSON 1.00 X 0 0 0 DAN SWANSON 1.00 X 0 0 0 CONNIE KRINKE 1.00 X 0 0 0 GALEN STRAND 1.00 X 0 0 0 DAVE LARSON 1.00 X 0 0 0 ROBERT SHECKLER 40.00 X 105870 0 15044 DENNIS GOEBEL 40.00 X 17696 0 0 BECKY HANSEN 40.00 X 86535 0 13475 DR THOMAS MATHESON 40.00 X 230689 0 14143 DR FORREST LANCHBURY 40.00 X 295016 0 14143 735806 0 56805 3 0 1 0 0 19874 428657 286577 735108 PATIENT SERVICE REVENU 621400 10887037 10887037 OTHER PROGRAM SERVICE 621400 50261 50261 MEAL REVENUE 621400 17450 17450 MEDICAL SERVICES 621400 2367 2367 10957115 41864 41864 150000 146179 3821 3821 3821 3953 19874 4554 -601 -601 11737307 10957115 0 45084 209701 209701 5237680 4820009 417671 551033 407189 143844 396037 349622 46415 18269 18269 8829 8829 30980 30980 1801765 1632369 169396 44087 331 43756 856761 712356 144405 237631 237631 146800 116354 30446 1125 1125 178901 178901 907326 907326 65045 65045 DIETARY FOOD AND SUPPLE 223540 223540 BAD DEBTS 162628 162628 RECRUITMENT 70397 23670 46727 DUES LICENSING & SUBSCR 58545 21216 37329 37345 19944 14686 2715 11244425 9878131 1363579 2715 437189 340419 82718 48215 1280365 1941213 152113 155151 8381 6527 14943653 10023541 5323502 4920112 1849260 2276439 418217 478075 9551745 10166151 881006 1215776 3450000 3225000 4331006 4440776 X 4714012 5178056 379615 420207 127112 127112 5220739 5725375 9551745 10166151 X 492882 11754 X 0 1 1 X 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 1 14736 6587 2715 18608 0 115112 5502 5502 115112 115112 10913 10913 115112 1.00000 1 0 75488 75488 8757440 5689287 3068153 5641888 4101882 1540006 468837 232372 236465 4920112 11737307 11244425 492882 45126 -33372 11754 504636 11692608 45126 45126 11647482 89825 89825 11737307 11246264 4554 4554 11241710 2715 2715 11244425 PART IV, LINE 1B: SOUTHWEST HEALTHCARE SERVICES HAS AN AUXILIARY THAT OPERATES UNDER THE SAME EIN AS SOUTHWEST HEALTHCARE SERVICES. DESCRIPTION OF INTENDED USE OF ENDOWMENT FUNDS: 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. ENDOWMENTS HELD AND ADMINISTERED BY UNRELATED ORGANIZATIONS: THE PRINCIPAL AMOUNTS OF THESE ENDOWMENTS ARE NOT REFLECTED IN THE ACCOMPANYING FINANCIAL STATEMENTS BECAUSE THE FUNDS ARE NOT CONTROLLED BY SOUTHWEST AND ARE TO REMAIN INTACT. THE INTEREST EARNED IS TO BE USED BY SOUTHWEST FOR CAPITAL IMPROVEMENTS AND OPERATIONS. THE VALUE OF THESE FUNDS AT THE END OF THE YEAR WAS $766,000. DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X: SOUTHWEST UNDERGOES AN ANNUAL ANALYSIS OF ITS VARIOUS TAX POSITIONS, ASSESSING THE LIKELIHOOD OF THESE POSITIONS BEING UPHELD UPON EXAMINATION WITH RELEVANT TAX AUTHORITIES. SOUTHWEST BELIEVES THAT IT IS COMPLIANT WITH ALL TAX REGULATIONS AND, AS OF DECEMBER 31, 2010, NO AMOUNTS WERE RECORDED AS A RESULT OF THIS ANALYSIS. IF SOUTHWEST HEALTHCARE SERVICES IS SUBJECT TO INTEREST OR PENALTIES ON UNDERPAID INCOME TAXES, THEY WILL BE REOCRDED AS INCOME TAX EXPENSE. SOUTHWEST BELIEVES IT IS NO LONGER SUBJECT TO FEDERAL AND STATE TAX EXAMINATIONS BY TAX AUTHORITIES FOR YEARS BEFORE 2007. PART XI, LINE 8 - OTHER ADJUSTMENTS: UNRESTRICTED NET ASSETS RELEASED FROM RESTRICTION 14,000. TEMPORARILY RESTRICTED NET ASSETS RELEASED FROM RESTRICTIONS -43,500. AUXILIARY NET INCOME -3,872. PART XII, LINE 4B - OTHER ADJUSTMENTS: AUXILIARY REVENUE 6,587. CONTRIBUTION REPORTED IN FUND BALANCE ON FINANCIAL STATEMENTS 84,092. FUNDRAISING EXPENSES REPORTED IN REVENUE ON FORM 990 -4,554. CONTRIBUTION REPORTED IN FUND BALANCE ON FINANCIAL STATEMENTS 3,700. PART XIII, LINE 2D - OTHER ADJUSTMENTS: FUNDRAISING EXPENSES REPORTED IN REVENUE ON FORM 990 4,554. PART XIII, LINE 4B - OTHER ADJUSTMENTS: AUXILIARY EXPENSES 2,715. CELEBRITY WAITER 23827 19874 3953 299 50 3655 500 50 23827 19874 3953 299 50 3655 500 50 4554 -601 1 1 X 1 X 1 X 125.000000000000 1 1 0 0 34084 34084 0.00310 188768 152566 36202 0.00330 222852 152566 70286 0.00640 222852 152566 70286 0.00640 0 145500 29100 2974807 3018778 -43971 X 1 1 1 1 SOUTHWEST HEALTHCARE SERVICES

14 6TH AVE SW BOWMAN ND 58623

X X X X NOT REQUIRED 1 4 SOUTHWEST HEALTHCARE SERVICES

802 2ND ST NW BOWMAN ND 58623

INDEPENDENT LIVING AND LTC SOUTHWEST HEALTHCARE SERVICES

12 6TH AV SW BOWMAN ND 58623

RURAL HEALTH CLINIC 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 PART I, LINE 7: THE ORGANIZATION USED WORKSHEET 2 TO DETERMINE THE COST TO CHARGE RATIO FOR PART I, LINE 7, ROWS A AND B. THE INFORMATION IN THE ABOVE TABLE WAS GATHERED FROM A VARIETY OF SOURCES: OUR ANNUAL AUDITED FINANCIAL INFORMATION, DETAILED REVENUE/PAYOR REPORTS FROM OUR ACCOUNTING SYSTEM. PART I, L7 COL(F): THE AMOUNT OF BAD DEBT EXPENSE REMOVED FROM THE DENOMINATOR WAS $162,628. PART II: MANY OF THE SOUTHWEST HEALTHCARE SERVICES STAFF ARE TRAINED IN THE INCIDENT COMMAND SYSTEM FOR EMERGENCY PREPAREDNESS. WE PARTICIPATE IN LOCAL AND REGIONAL EMERGENCY DRILLS WITH LOCAL AUTHORITIES TO ASSIST US IN BEING PREPARED FOR MAJOR EMERGENCIES THAT COULD OCCUR IN OUR COMMUNITY. OUR EMS SERVICE STAFF PROVIDES CPR TRAINING (FOR A NOMINAL FEE) TO THOSE IN OUR COMMUNITY WHO ARE INTERESTED. THE HEALTH FAIRS/SCREENINGS THAT WE PROVIDE PERIODICALLY ARE A MEANS TO PROMOTE HEALTHY LIVING AND PREVENTIVE CARE TO OUR COMMUNITY. SOUTHWEST HEALTHCARE SERVICES EXTENDS EMERGENCY CARE SERVICES TO ALL PATIENTS IN OUR SERVICE AREA. PART III, LINE 4: FINANCIAL STATEMENT BAD DEBT EXPENSE FOOTNOTE: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.THE BAD DEBT EXPENSE AT COST IN PART III, SECTION A, LINE 2 IS CALCULATED USING WORKSHEET 2.PATIENTS ARE ASKED TO COMPLETE A FINANCIAL ASSISTANCE APPLICATION FOR CHARITY. THEIR ELIGIBILITY IS DETERMINED BY MEETING THE FOLLOWING CRITERIA: INCOME, EXPENSES, AND THE FEDERAL POVERTY GUIDELINES. A PATIENT MAY QUALIFY BY THE USE OF A SLIDING SCALE APPROACH, MEDICAL INDIGENCE OR THE PATIENT MAY BE PRESUMPTIVELY ELIGIBLE.WHEN A PATIENT QUALIFIES FOR ASSISTANCE UTILIZING THE ABOVE CRITERIA AN ADJUSTMENT FORM IS COMPLETED BY THE PATIENT REP AND FORWARDED TO THE CFO FOR AN APPROVAL SIGNATURE.WE REVIEW THE ACCOUNTS ON AN INDIVIDUAL BASIS WHEN WE TURN THEM OVER TO BAD DEBT. BASED ON WHAT WE SEE WHEN WE REVIEW THEM WE ESTIMATE THAT 20% OF THE BAD DEBT EXPENSE IS ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER OUR CHARITY CARE POLICY. WE CONSIDER THAT IF THEY WOULD HAVE DONE THE PAPERWORK REQUIRED TO OBTAIN CHARITY CARE, THEY MAY HAVE QUALIFIED. SOUTHWEST HEALTHCARE SERVICES DOES NOT REFUSE SERVICE TO PATIENTS THAT GENERATE BAD DEBT, AND THIS IS EVIDENCE THAT THE CARE IS GIVEN FOR COMMUNITY BENEFIT MOTIVATIONS. 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 2010 MEDICARE COST REPORT. 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 VI, LINE 2: A COMMUNITY WIDE NEEDS ASSESSMENT WAS COMPLETED IN 2007 AND WE WILL CONTINUE TO DO THESE ASSESSMENTS IN OUR COMMUNITY EVERY THREE YEARS, AS IS NOW REQUIRED, BEGINNING WITH THE 2013 SURVEY. SURVEY INFORMATION IS GATHERED FROM THE COMMUNITY AND THEN COMPILED IN A COMPREHENSIVE REPORT THAT WE REVIEW AND TRY TO ALIGN OUR STRATEGIC PLAN TO MEET COMMUNITY NEEDS. WE ARE IN THE INITIAL PLANNING STAGES FOR THE COMMUNITY HEALTH NEEDS ASSESSMENT AND WE ANTICIPATE A COMPLETION DATE OF 2013. PART VI, LINE 3: TRAINED STAFF WORK WITH THE PATIENTS ON AN INDIVIDUAL BASIS TO DETERMINE ELIGIBILITY FOR ASSISTANCE. UPON ADMISSION, STAFF CONSULT WITH THE PATIENT/FAMILY REGARDING PAYMENT OPTIONS. WE CONTINUE TO ENHANCE THIS AREA OF OUR BUSINESS AND ARE CREATING SOME EDUCATION MATERIALS THAT WILL ASSIST US WITH COMMUNICATING THESE OPPORTUNITIES TO CLIENTS/PATIENTS IN OUR SERVICE AREA. ALSO, OUR FINANCIAL ASSISTANCE POLICY IS POSTED ON OUR WEBSITE. 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 CLNIC IN OUR CITY LIMITS THAT IS OPERATED BY ANOTHER HEALTHCARE FACILITY WHICH IS 40 MILES FROM OUR CITY. PART VI, LINE 6: 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. 1 STUDENT LOAN REPAYMENT 4 7200 TUITION SUBSIDY 3 28015 PROCEDURE FOR MONITORING GRANTS IN THE U.S.: PART I, LINE 2: SCHEDULE I, PART I, LINE 2: SOUTHWEST HEALTHCARE SERVICES OFFERS LOAN REPAYMENT ASSISTANCE TO EMPLOYEES WHO QUALIFY UNDER THE REQUIREMENTS OF THEIR NURSING LOAN REPAYMENT POLICY. THE ORGANIZATION USES THE POLICY PROCEDURES IN MONITORING THE USE OF GRANT FUNDS IN A COMPLIANT MANOR. NURSING STAFF SUBMIT DOCUMENTATION RELATED TO THEIR STUDENT LOANS IN ORDER FOR US TO DETERMINE IF THEY QUALIFY FOR THE LOAN REPAYMENT ASSISTANCE PROVIDED BY SOUTHWEST HEALTHCARE SERVICES. IN REGARD TO THE TUITION SUBSIDY THAT IS PAYABLE TO THE UNIVERSITY OF SOUTH DAKOTA, WE PARTICIPATED IN A GROW YOUR OWN NURSING PROGRAM AND THREE OF OUR STAFF RECEIVED THEIR NURSING DEGRESS THROUGH THIS PROGRAM. WE PROVIDED THIS TUITION SUBSIDY WHICH IS BASED ON THE NUMBER OF CREDIT HOURS ENROLLED IN AS WELL AS THE TOTAL NUMBER OF PARTICIPANTS IN THE PROGRAM. X 0 1 X X X 1 0 0 0 0 0 0 1 0 DR THOMAS MATHESON 230689 0 0 0 0 0 0 0 14143 0 244832 0 0 0 DR FORREST LANCHBURY 295016 0 0 0 0 0 0 0 14143 0 309159 0 0 0 PART I, LINE 1A HOUSING ALLOWANCE FOR DENNIS GOEBEL. THE SOUTHWEST HEALTHCARE SERVICES BOARD OF DIRECTORS DETERMINED THIS THROUGH A CONTRACT WITH THE INTERIM CEO. PART I, LINE 4A ROBERT SHECKLER $27,500 PART I, LINE 7 SOME PHYSICIANS ARE ELIGIBLE FOR A PRODUCTION INCENTIVE IN ADDITION TO BASE PAY. CITY OF BOWMAN NORTH DAKOTA 456002040 10302TAA8 2006-08-03 3902372 REFINANCE EXISTING DEBT AND FINANCE A BUILDING PROJECT 0 0 0 3902372 2342200 78100 1482072 2005 0 1 0 1 0 0 0 0 0 0.00000 0.00000 0.00000 1 0 0 0 0 0 0 FORM 990, PART VI, SECTION A, LINE 1 COMMITTEES THAT ACT ON BEHALF OF THE BOARD: FINANCE COMMITTEE, BUILDING COMMITTEE, QUALITY ASSURANCE COMMITTEE ARE ALL COMMITTEES THAT ARE COMPOSED OF CURRENT BOARD MEMBERS AND ALL MAKE RECOMMENDATIONS TO THE BOARD OF DIRECTORS TO BE PRESENTED FOR VOTE BY THE ENTIRE BOARD OF DIRECTORS. 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. FORM 990, PART VI, SECTION B, LINE 12C ALL OFFICERS, DIRECTORS, AND KEY EMPLOYEES ARE REQUIRED TO FILL OUT 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. THIS PROCESS TAKES PLACE ON AN ANNUAL BASIS. 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. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: NET UNREALIZED GAINS ON INVESTMENTS: 45,126. UNRESTRICTED NET ASSETS RELEASED FROM RESTRICTION 14,000. TEMPORARILY RESTRICTED NET ASSETS RELEASED FROM RESTRICTIONS -43,500. AUXILIARY NET INCOME -3,872. TOTAL TO FORM 990, PART XI, LINE 5: 11,754. SOUTHWEST HEALTHCARE AUXILIARY 802 2ND ST NW BOWMAN ND 58623 450458242 CHARITABLE EVENTS TO HELP RAISE FUNDS FOR THE SWHC FACILITY. ND 6587 18608 N/A