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      </Form990PartVIISectionAGrp>
      <TotalReportableCompFromOrgAmt>1778094</TotalReportableCompFromOrgAmt>
      <TotReportableCompRltdOrgAmt>0</TotReportableCompRltdOrgAmt>
      <TotalOtherCompensationAmt>32421</TotalOtherCompensationAmt>
      <IndivRcvdGreaterThan100KCnt>10</IndivRcvdGreaterThan100KCnt>
      <FormerOfcrEmployeesListedInd>0</FormerOfcrEmployeesListedInd>
      <TotalCompGreaterThan150KInd>1</TotalCompGreaterThan150KInd>
      <CompensationFromOtherSrcsInd>0</CompensationFromOtherSrcsInd>
      <ContractorCompensationGrp>
        <ContractorName>
          <BusinessName>
            <BusinessNameLine1Txt>MICIL LLC</BusinessNameLine1Txt>
          </BusinessName>
        </ContractorName>
        <ContractorAddress>
          <USAddress>
            <AddressLine1Txt>2908 Dortmund Drive</AddressLine1Txt>
            <CityNm>Bismarck</CityNm>
            <StateAbbreviationCd>ND</StateAbbreviationCd>
            <ZIPCd>58504</ZIPCd>
          </USAddress>
        </ContractorAddress>
        <ServicesDesc>Nursing Coverage</ServicesDesc>
        <CompensationAmt>589676</CompensationAmt>
      </ContractorCompensationGrp>
      <ContractorCompensationGrp>
        <ContractorName>
          <BusinessName>
            <BusinessNameLine1Txt>Psychiatric Medical Care LLC</BusinessNameLine1Txt>
          </BusinessName>
        </ContractorName>
        <ContractorAddress>
          <USAddress>
            <AddressLine1Txt>PO Box 734606</AddressLine1Txt>
            <CityNm>Dallas</CityNm>
            <StateAbbreviationCd>TX</StateAbbreviationCd>
            <ZIPCd>75373</ZIPCd>
          </USAddress>
        </ContractorAddress>
        <ServicesDesc>Behavioral Health Coverage</ServicesDesc>
        <CompensationAmt>491615</CompensationAmt>
      </ContractorCompensationGrp>
      <ContractorCompensationGrp>
        <ContractorName>
          <BusinessName>
            <BusinessNameLine1Txt>E R Gard Corp</BusinessNameLine1Txt>
          </BusinessName>
        </ContractorName>
        <ContractorAddress>
          <USAddress>
            <AddressLine1Txt>PO Box A</AddressLine1Txt>
            <CityNm>Bowman</CityNm>
            <StateAbbreviationCd>ND</StateAbbreviationCd>
            <ZIPCd>58623</ZIPCd>
          </USAddress>
        </ContractorAddress>
        <ServicesDesc>Physician Coverage</ServicesDesc>
        <CompensationAmt>424106</CompensationAmt>
      </ContractorCompensationGrp>
      <ContractorCompensationGrp>
        <ContractorName>
          <BusinessName>
            <BusinessNameLine1Txt>Roy Cordy MD</BusinessNameLine1Txt>
          </BusinessName>
        </ContractorName>
        <ContractorAddress>
          <USAddress>
            <AddressLine1Txt>2100 S Ocean Dr 14G</AddressLine1Txt>
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            <StateAbbreviationCd>FL</StateAbbreviationCd>
            <ZIPCd>33316</ZIPCd>
          </USAddress>
        </ContractorAddress>
        <ServicesDesc>Physician Coverage</ServicesDesc>
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      <ContractorCompensationGrp>
        <ContractorName>
          <BusinessName>
            <BusinessNameLine1Txt>LRS Healthcare</BusinessNameLine1Txt>
          </BusinessName>
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        <ContractorAddress>
          <USAddress>
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        </ContractorAddress>
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      <CntrctRcvdGreaterThan100KCnt>9</CntrctRcvdGreaterThan100KCnt>
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      <GovernmentGrantsAmt>180109</GovernmentGrantsAmt>
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      <TotalContributionsAmt>714702</TotalContributionsAmt>
      <ProgramServiceRevenueGrp>
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      <ProgramServiceRevenueGrp>
        <Desc>Pharmacy Revenue</Desc>
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      <ProgramServiceRevenueGrp>
        <Desc>Supporting Revenue</Desc>
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        <ExclusionAmt>31799</ExclusionAmt>
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      <GainOrLossGrp>
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      </GainOrLossGrp>
      <NetGainOrLossInvestmentsGrp>
        <TotalRevenueColumnAmt>78594</TotalRevenueColumnAmt>
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      <NetIncmFromFundraisingEvtGrp>
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        <ExclusionAmt>133016</ExclusionAmt>
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      <FeesForServicesLegalGrp>
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        <ManagementAndGeneralAmt>5564</ManagementAndGeneralAmt>
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        <ManagementAndGeneralAmt>96212</ManagementAndGeneralAmt>
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        <ManagementAndGeneralAmt>75442</ManagementAndGeneralAmt>
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      <OfficeExpensesGrp>
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        <ProgramServicesAmt>191661</ProgramServicesAmt>
        <ManagementAndGeneralAmt>82589</ManagementAndGeneralAmt>
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      <OccupancyGrp>
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        <ProgramServicesAmt>325335</ProgramServicesAmt>
        <ManagementAndGeneralAmt>36639</ManagementAndGeneralAmt>
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      <TravelGrp>
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        <ProgramServicesAmt>68087</ProgramServicesAmt>
        <ManagementAndGeneralAmt>4402</ManagementAndGeneralAmt>
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      <InterestGrp>
        <TotalAmt>423281</TotalAmt>
        <ProgramServicesAmt>423281</ProgramServicesAmt>
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        <ProgramServicesAmt>2102125</ProgramServicesAmt>
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      <InsuranceGrp>
        <TotalAmt>118224</TotalAmt>
        <ManagementAndGeneralAmt>118224</ManagementAndGeneralAmt>
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      <OtherExpensesGrp>
        <Desc>Medical Supplies</Desc>
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        <ProgramServicesAmt>1230228</ProgramServicesAmt>
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      <OtherExpensesGrp>
        <Desc>Dietary Food and Supple</Desc>
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        <ProgramServicesAmt>181181</ProgramServicesAmt>
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      <OtherExpensesGrp>
        <Desc>Dues &amp; Subscriptions</Desc>
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        <ProgramServicesAmt>24708</ProgramServicesAmt>
        <ManagementAndGeneralAmt>41351</ManagementAndGeneralAmt>
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      <AllOtherExpensesGrp>
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        <ProgramServicesAmt>1912</ProgramServicesAmt>
        <ManagementAndGeneralAmt>18212</ManagementAndGeneralAmt>
        <FundraisingAmt>14557</FundraisingAmt>
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      <TotalFunctionalExpensesGrp>
        <TotalAmt>18515844</TotalAmt>
        <ProgramServicesAmt>15564036</ProgramServicesAmt>
        <ManagementAndGeneralAmt>2937251</ManagementAndGeneralAmt>
        <FundraisingAmt>14557</FundraisingAmt>
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      <SavingsAndTempCashInvstGrp>
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        <EOYAmt>1498878</EOYAmt>
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        <EOYAmt>2348893</EOYAmt>
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        <EOYAmt>491422</EOYAmt>
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      <PrepaidExpensesDefrdChargesGrp>
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        <EOYAmt>131064</EOYAmt>
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      <LandBldgEquipCostOrOtherBssAmt>50116343</LandBldgEquipCostOrOtherBssAmt>
      <LandBldgEquipAccumDeprecAmt>28102586</LandBldgEquipAccumDeprecAmt>
      <LandBldgEquipBasisNetGrp>
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        <EOYAmt>22013757</EOYAmt>
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      <InvestmentsPubTradedSecGrp>
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        <EOYAmt>3008860</EOYAmt>
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        <BOYAmt>1211162</BOYAmt>
        <EOYAmt>2395402</EOYAmt>
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      <TotalAssetsGrp>
        <BOYAmt>32662455</BOYAmt>
        <EOYAmt>31888276</EOYAmt>
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        <EOYAmt>1958792</EOYAmt>
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      <EscrowAccountLiabilityGrp>
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        <EOYAmt>24269</EOYAmt>
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      <MortgNotesPyblScrdInvstPropGrp>
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        <EOYAmt>23796469</EOYAmt>
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        <EOYAmt>178159</EOYAmt>
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        <BOYAmt>26090919</BOYAmt>
        <EOYAmt>25957689</EOYAmt>
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      <OrganizationFollowsFASB117Ind>X</OrganizationFollowsFASB117Ind>
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        <EOYAmt>4646251</EOYAmt>
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      <DonorRestrictionNetAssetsGrp>
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        <EOYAmt>1284336</EOYAmt>
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        <EOYAmt>5930587</EOYAmt>
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        <EOYAmt>31888276</EOYAmt>
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      <InfoInScheduleOPartXIInd>X</InfoInScheduleOPartXIInd>
      <ReconcilationRevenueExpnssAmt>-872322</ReconcilationRevenueExpnssAmt>
      <NetUnrlzdGainsLossesInvstAmt>32491</NetUnrlzdGainsLossesInvstAmt>
      <OtherChangesInNetAssetsAmt>198882</OtherChangesInNetAssetsAmt>
      <MethodOfAccountingAccrualInd>X</MethodOfAccountingAccrualInd>
      <AccountantCompileOrReviewInd>0</AccountantCompileOrReviewInd>
      <FSAuditedInd>1</FSAuditedInd>
      <FSAuditedBasisGrp>
        <SeparateBasisFinclStmtInd>X</SeparateBasisFinclStmtInd>
      </FSAuditedBasisGrp>
      <AuditCommitteeInd>1</AuditCommitteeInd>
      <FederalGrantAuditRequiredInd>0</FederalGrantAuditRequiredInd>
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    <IRS990ScheduleA documentId="RetDoc1039100001">
      <HospitalInd>X</HospitalInd>
    </IRS990ScheduleA>
    <IRS990ScheduleB documentId="RetDoc1234500001">
      <ContributorInformationGrp>
        <ContributorNum>RESTRICTED</ContributorNum>
        <ContributorBusinessName>
          <BusinessNameLine1>RESTRICTED</BusinessNameLine1>
        </ContributorBusinessName>
        <ContributorUSAddress>
          <AddressLine1>RESTRICTED</AddressLine1>
          <AddressLine2>RESTRICTED</AddressLine2>
          <City>RESTRICTED</City>
          <State>RESTRICTED</State>
          <ZIPCode>RESTRICTED</ZIPCode>
        </ContributorUSAddress>
        <TotalContributionsAmt>RESTRICTED</TotalContributionsAmt>
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    <IRS990ScheduleD documentId="RetDoc1040000001">
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      <BeginningBalanceAmt>22160</BeginningBalanceAmt>
      <AdditionsDuringYearAmt>9029</AdditionsDuringYearAmt>
      <DistributionsDuringYearAmt>14557</DistributionsDuringYearAmt>
      <EndingBalanceAmt>16632</EndingBalanceAmt>
      <InclEscrowCustodialAcctLiabInd>1</InclEscrowCustodialAcctLiabInd>
      <ExplanationProvidedInd>X</ExplanationProvidedInd>
      <CYEndwmtFundGrp>
        <BeginningYearBalanceAmt>118258</BeginningYearBalanceAmt>
        <InvestmentEarningsOrLossesAmt>14143</InvestmentEarningsOrLossesAmt>
        <EndYearBalanceAmt>132401</EndYearBalanceAmt>
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      <CYMinus1YrEndwmtFundGrp>
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        <InvestmentEarningsOrLossesAmt>16033</InvestmentEarningsOrLossesAmt>
        <EndYearBalanceAmt>118258</EndYearBalanceAmt>
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      <CYMinus2YrEndwmtFundGrp>
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        <InvestmentEarningsOrLossesAmt>-24887</InvestmentEarningsOrLossesAmt>
        <EndYearBalanceAmt>102225</EndYearBalanceAmt>
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        <InvestmentEarningsOrLossesAmt>14308</InvestmentEarningsOrLossesAmt>
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        <EndYearBalanceAmt>127112</EndYearBalanceAmt>
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        <EndYearBalanceAmt>127112</EndYearBalanceAmt>
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      <BoardDesignatedBalanceEOYPct>0.00000</BoardDesignatedBalanceEOYPct>
      <PrmnntEndowmentBalanceEOYPct>0.96005</PrmnntEndowmentBalanceEOYPct>
      <TermEndowmentBalanceEOYPct>0.03995</TermEndowmentBalanceEOYPct>
      <EndowmentsHeldUnrelatedOrgInd>1</EndowmentsHeldUnrelatedOrgInd>
      <EndowmentsHeldRelatedOrgInd>0</EndowmentsHeldRelatedOrgInd>
      <LandGrp>
        <OtherCostOrOtherBasisAmt>75488</OtherCostOrOtherBasisAmt>
        <BookValueAmt>75488</BookValueAmt>
      </LandGrp>
      <BuildingsGrp>
        <OtherCostOrOtherBasisAmt>41552169</OtherCostOrOtherBasisAmt>
        <DepreciationAmt>21112789</DepreciationAmt>
        <BookValueAmt>20439380</BookValueAmt>
      </BuildingsGrp>
      <EquipmentGrp>
        <OtherCostOrOtherBasisAmt>8182703</OtherCostOrOtherBasisAmt>
        <DepreciationAmt>6989797</DepreciationAmt>
        <BookValueAmt>1192906</BookValueAmt>
      </EquipmentGrp>
      <OtherLandBuildingsGrp>
        <OtherCostOrOtherBasisAmt>305983</OtherCostOrOtherBasisAmt>
        <BookValueAmt>305983</BookValueAmt>
      </OtherLandBuildingsGrp>
      <TotalBookValueLandBuildingsAmt>22013757</TotalBookValueLandBuildingsAmt>
      <OtherAssetsOrgGrp>
        <Desc>Other Assets</Desc>
        <BookValueAmt>10000</BookValueAmt>
      </OtherAssetsOrgGrp>
      <OtherAssetsOrgGrp>
        <Desc>Receiveable from Sunrise Foudation</Desc>
        <BookValueAmt>1151935</BookValueAmt>
      </OtherAssetsOrgGrp>
      <OtherAssetsOrgGrp>
        <Desc>Estimated Third-Party Payor Settlement</Desc>
        <BookValueAmt>1063523</BookValueAmt>
      </OtherAssetsOrgGrp>
      <OtherAssetsOrgGrp>
        <Desc>Right of Use Asset</Desc>
        <BookValueAmt>169944</BookValueAmt>
      </OtherAssetsOrgGrp>
      <TotalBookValueOtherAssetsAmt>2395402</TotalBookValueOtherAssetsAmt>
      <OtherLiabilitiesOrgGrp>
        <Desc>Right of Use Liability</Desc>
        <Amt>178159</Amt>
      </OtherLiabilitiesOrgGrp>
      <TotalLiabilityAmt>178159</TotalLiabilityAmt>
      <FootnoteTextInd>X</FootnoteTextInd>
      <TotalRevEtcAuditedFinclStmtAmt>17873642</TotalRevEtcAuditedFinclStmtAmt>
      <NetUnrealizedGainsInvstAmt>32491</NetUnrealizedGainsInvstAmt>
      <OtherRevenueAmt>193354</OtherRevenueAmt>
      <RevenueNotReportedAmt>225845</RevenueNotReportedAmt>
      <RevenueSubtotalAmt>17647797</RevenueSubtotalAmt>
      <OtherRevenuesNotIncludedAmt>-4275</OtherRevenuesNotIncludedAmt>
      <RevenueNotReportedFinclStmtAmt>-4275</RevenueNotReportedFinclStmtAmt>
      <TotalRevenuePerForm990Amt>17643522</TotalRevenuePerForm990Amt>
      <TotExpnsEtcAuditedFinclStmtAmt>18514591</TotExpnsEtcAuditedFinclStmtAmt>
      <OtherExpensesIncludedAmt>13304</OtherExpensesIncludedAmt>
      <ExpensesNotReportedAmt>13304</ExpensesNotReportedAmt>
      <ExpensesSubtotalAmt>18501287</ExpensesSubtotalAmt>
      <OtherExpensesNotIncludedAmt>14557</OtherExpensesNotIncludedAmt>
      <ExpensesNotRptFinclStmtAmt>14557</ExpensesNotRptFinclStmtAmt>
      <TotalExpensesPerForm990Amt>18515844</TotalExpensesPerForm990Amt>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Part IV, Line 1b:</FormAndLineReferenceDesc>
        <ExplanationTxt>Southwest Healthcare Services has an auxiliary that operates under the same EIN as Southwest Healthcare Services.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Part IV, Line 2b:</FormAndLineReferenceDesc>
        <ExplanationTxt>Southwest acts as custodian for the funds of residents. These funds are included in cash and accounts payable in the financial statements. Resident trust funds totaled $1,603 and $1,219 and assisted living security deposits totaled $22,666 at December 31, 2024 and 2023.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Part V, Line 4:</FormAndLineReferenceDesc>
        <ExplanationTxt>Endowments held and administered by Southwest Healthcare Services: The principal of $127,112 is permanently restricted. The earnings from the principal balance are for hospital operations and to support assisted living, as necessary. From time to time, certain donor-restricted endowment funds may have fair values less than the amounts required to be maintained by donors or law (underwater endowments). Southwest has interpreted UPMIFA to permit spending from underwater endowments in accordance with prudent measures required under law. At December 31, 2023, funds with original gift values of $127,112, fair values of $118,258, and deficiencies of $8,854 were reported in net assets with donor restrictions. These amounts were fully recovered during December 31, 2024 due to favorable market fluctuations.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Part X, Line 2:</FormAndLineReferenceDesc>
        <ExplanationTxt>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.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Part XI, Line 2d - Other Adjustments:</FormAndLineReferenceDesc>
        <ExplanationTxt>Change in Sunrise Receivable 193,354.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Part XI, Line 4b - Other Adjustments:</FormAndLineReferenceDesc>
        <ExplanationTxt>Auxiliary Revenue 9,029. Fundraising Expenses reported in Revenue on Form 990 -13,304.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Part XII, Line 2d - Other Adjustments:</FormAndLineReferenceDesc>
        <ExplanationTxt>Fundraising Expenses reported in Revenue on Form 990 13,304.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Part XII, Line 4b - Other Adjustments:</FormAndLineReferenceDesc>
        <ExplanationTxt>Auxiliary Expenses 14,557.</ExplanationTxt>
      </SupplementalInformationDetail>
    </IRS990ScheduleD>
    <IRS990ScheduleG documentId="RetDoc1041300001">
      <FundraisingEventInformationGrp>
        <Event1Nm>Celebrity Waiter</Event1Nm>
        <GrossReceiptsEvent1Amt>71885</GrossReceiptsEvent1Amt>
        <CharitableContriEvent1Amt>35958</CharitableContriEvent1Amt>
        <GrossRevenueEvent1Amt>35927</GrossRevenueEvent1Amt>
        <CashPrizesEvent1Amt>2450</CashPrizesEvent1Amt>
        <NonCashPrizesEvent1Amt>3007</NonCashPrizesEvent1Amt>
        <RentFacilityCostsEvent1Amt>725</RentFacilityCostsEvent1Amt>
        <FoodAndBeverageEvent1Amt>5142</FoodAndBeverageEvent1Amt>
        <EntertainmentEvent1Amt>250</EntertainmentEvent1Amt>
        <OtherDirectExpensesEvent1Amt>1730</OtherDirectExpensesEvent1Amt>
        <GrossReceiptsTotalAmt>71885</GrossReceiptsTotalAmt>
        <CharitableContributionsTotAmt>35958</CharitableContributionsTotAmt>
        <GrossRevenueTotalEventsAmt>35927</GrossRevenueTotalEventsAmt>
        <CashPrizesTotalEventsAmt>2450</CashPrizesTotalEventsAmt>
        <NonCashPrizesTotalEventsAmt>3007</NonCashPrizesTotalEventsAmt>
        <RentFcltyCostsTotalEventsAmt>725</RentFcltyCostsTotalEventsAmt>
        <FoodAndBeverageTotalEventsAmt>5142</FoodAndBeverageTotalEventsAmt>
        <EntertainmentTotalEventsAmt>250</EntertainmentTotalEventsAmt>
        <OthDirectExpnssTotalEventsAmt>1730</OthDirectExpnssTotalEventsAmt>
        <DirectExpenseSummaryEventsAmt>13304</DirectExpenseSummaryEventsAmt>
        <NetIncomeSummaryAmt>22623</NetIncomeSummaryAmt>
      </FundraisingEventInformationGrp>
    </IRS990ScheduleG>
    <IRS990ScheduleH documentId="RetDoc1041500001">
      <FinancialAssistancePolicyInd>1</FinancialAssistancePolicyInd>
      <WrittenPolicyInd>1</WrittenPolicyInd>
      <AllHospitalsPolicyInd>X</AllHospitalsPolicyInd>
      <FPGReferenceFreeCareInd>1</FPGReferenceFreeCareInd>
      <Percent100Ind>X</Percent100Ind>
      <FPGReferenceDiscountedCareInd>1</FPGReferenceDiscountedCareInd>
      <Percent200DInd>X</Percent200DInd>
      <FreeCareMedicallyIndigentInd>1</FreeCareMedicallyIndigentInd>
      <FinancialAssistanceBudgetInd>1</FinancialAssistanceBudgetInd>
      <ExpensesExceedBudgetInd>1</ExpensesExceedBudgetInd>
      <UnableToProvideCareInd>0</UnableToProvideCareInd>
      <AnnualCommunityBnftReportInd>1</AnnualCommunityBnftReportInd>
      <ReportPublicallyAvailableInd>1</ReportPublicallyAvailableInd>
      <FinancialAssistanceAtCostTyp>
        <TotalCommunityBenefitExpnsAmt>93000</TotalCommunityBenefitExpnsAmt>
        <NetCommunityBenefitExpnsAmt>93000</NetCommunityBenefitExpnsAmt>
        <TotalExpensePct>0.00500</TotalExpensePct>
      </FinancialAssistanceAtCostTyp>
      <UnreimbursedMedicaidGrp>
        <TotalCommunityBenefitExpnsAmt>495127</TotalCommunityBenefitExpnsAmt>
        <DirectOffsettingRevenueAmt>295667</DirectOffsettingRevenueAmt>
        <NetCommunityBenefitExpnsAmt>199460</NetCommunityBenefitExpnsAmt>
        <TotalExpensePct>0.01080</TotalExpensePct>
      </UnreimbursedMedicaidGrp>
      <TotalFinancialAssistanceTyp>
        <TotalCommunityBenefitExpnsAmt>588127</TotalCommunityBenefitExpnsAmt>
        <DirectOffsettingRevenueAmt>295667</DirectOffsettingRevenueAmt>
        <NetCommunityBenefitExpnsAmt>292460</NetCommunityBenefitExpnsAmt>
        <TotalExpensePct>0.01580</TotalExpensePct>
      </TotalFinancialAssistanceTyp>
      <CommunityHealthServicesGrp>
        <TotalCommunityBenefitExpnsAmt>26380</TotalCommunityBenefitExpnsAmt>
        <DirectOffsettingRevenueAmt>3950</DirectOffsettingRevenueAmt>
        <NetCommunityBenefitExpnsAmt>22430</NetCommunityBenefitExpnsAmt>
        <TotalExpensePct>0.00120</TotalExpensePct>
      </CommunityHealthServicesGrp>
      <SubsidizedHealthServicesGrp>
        <TotalCommunityBenefitExpnsAmt>4137448</TotalCommunityBenefitExpnsAmt>
        <DirectOffsettingRevenueAmt>3035433</DirectOffsettingRevenueAmt>
        <NetCommunityBenefitExpnsAmt>1102015</NetCommunityBenefitExpnsAmt>
        <TotalExpensePct>0.05950</TotalExpensePct>
      </SubsidizedHealthServicesGrp>
      <TotalOtherBenefitsGrp>
        <TotalCommunityBenefitExpnsAmt>4163828</TotalCommunityBenefitExpnsAmt>
        <DirectOffsettingRevenueAmt>3039383</DirectOffsettingRevenueAmt>
        <NetCommunityBenefitExpnsAmt>1124445</NetCommunityBenefitExpnsAmt>
        <TotalExpensePct>0.06070</TotalExpensePct>
      </TotalOtherBenefitsGrp>
      <TotalCommunityBenefitsGrp>
        <TotalCommunityBenefitExpnsAmt>4751955</TotalCommunityBenefitExpnsAmt>
        <DirectOffsettingRevenueAmt>3335050</DirectOffsettingRevenueAmt>
        <NetCommunityBenefitExpnsAmt>1416905</NetCommunityBenefitExpnsAmt>
        <TotalExpensePct>0.07650</TotalExpensePct>
      </TotalCommunityBenefitsGrp>
      <HealthImprovementAdvocacyGrp>
        <ActivitiesOrProgramsCnt>3</ActivitiesOrProgramsCnt>
        <PersonsServedCnt>100</PersonsServedCnt>
        <TotalCommunityBenefitExpnsAmt>23152</TotalCommunityBenefitExpnsAmt>
        <DirectOffsettingRevenueAmt>5625</DirectOffsettingRevenueAmt>
        <NetCommunityBenefitExpnsAmt>17527</NetCommunityBenefitExpnsAmt>
        <TotalExpensePct>0.00090</TotalExpensePct>
      </HealthImprovementAdvocacyGrp>
      <TotalCommuntityBuildingActyGrp>
        <ActivitiesOrProgramsCnt>3</ActivitiesOrProgramsCnt>
        <PersonsServedCnt>100</PersonsServedCnt>
        <TotalCommunityBenefitExpnsAmt>23152</TotalCommunityBenefitExpnsAmt>
        <DirectOffsettingRevenueAmt>5625</DirectOffsettingRevenueAmt>
        <NetCommunityBenefitExpnsAmt>17527</NetCommunityBenefitExpnsAmt>
        <TotalExpensePct>0.00090</TotalExpensePct>
      </TotalCommuntityBuildingActyGrp>
      <BadDebtExpenseReportedInd>1</BadDebtExpenseReportedInd>
      <BadDebtExpenseAmt>182161</BadDebtExpenseAmt>
      <BadDebtExpenseAttributableAmt>36432</BadDebtExpenseAttributableAmt>
      <ReimbursedByMedicareAmt>5016739</ReimbursedByMedicareAmt>
      <CostOfCareReimbursedByMedcrAmt>5053704</CostOfCareReimbursedByMedcrAmt>
      <MedicareSurplusOrShortfallAmt>-36965</MedicareSurplusOrShortfallAmt>
      <CostingMethodologyUsedGrp>
        <OtherInd>X</OtherInd>
      </CostingMethodologyUsedGrp>
      <WrittenDebtCollectionPolicyInd>1</WrittenDebtCollectionPolicyInd>
      <FinancialAssistancePrvsnInd>1</FinancialAssistancePrvsnInd>
      <HospitalFacilitiesCnt>1</HospitalFacilitiesCnt>
      <HospitalFacilitiesGrp>
        <FacilityNum>1</FacilityNum>
        <BusinessName>
          <BusinessNameLine1Txt>Southwest Healthcare Services</BusinessNameLine1Txt>
        </BusinessName>
        <USAddress>
          <AddressLine1Txt>802 2nd St NW</AddressLine1Txt>
          <CityNm>Bowman</CityNm>
          <StateAbbreviationCd>ND</StateAbbreviationCd>
          <ZIPCd>58623</ZIPCd>
        </USAddress>
        <StateLicenseNum>5006</StateLicenseNum>
        <LicensedHospitalInd>X</LicensedHospitalInd>
        <GeneralMedicalAndSurgicalInd>X</GeneralMedicalAndSurgicalInd>
        <CriticalAccessHospitalInd>X</CriticalAccessHospitalInd>
        <EmergencyRoom24HrsInd>X</EmergencyRoom24HrsInd>
        <OtherDesc>One provider based rural health clinic</OtherDesc>
      </HospitalFacilitiesGrp>
      <HospitalFcltyPoliciesPrctcGrp>
        <HospitalFacilityName>
          <BusinessNameLine1Txt>Southwest Healthcare Services</BusinessNameLine1Txt>
        </HospitalFacilityName>
        <FacilityNum>1</FacilityNum>
        <FirstLicensedCYOrPYInd>0</FirstLicensedCYOrPYInd>
        <TaxExemptHospitalCYOrPYInd>0</TaxExemptHospitalCYOrPYInd>
        <CHNAConductedInd>1</CHNAConductedInd>
        <CommunityDefinitionInd>X</CommunityDefinitionInd>
        <CommunityDemographicsInd>X</CommunityDemographicsInd>
        <ExistingResourcesInd>X</ExistingResourcesInd>
        <HowDataObtainedInd>X</HowDataObtainedInd>
        <CommunityHealthNeedsInd>X</CommunityHealthNeedsInd>
        <OtherHealthIssuesInd>X</OtherHealthIssuesInd>
        <CommunityHlthNeedsIdProcessInd>X</CommunityHlthNeedsIdProcessInd>
        <ConsultingProcessInd>X</ConsultingProcessInd>
        <PriorCHNAImpactInd>X</PriorCHNAImpactInd>
        <CHNAConductedYr>22</CHNAConductedYr>
        <TakeIntoAccountOthersInputInd>1</TakeIntoAccountOthersInputInd>
        <CHNAConductedWithOtherFcltsInd>0</CHNAConductedWithOtherFcltsInd>
        <CHNAConductedWithNonFcltsInd>0</CHNAConductedWithNonFcltsInd>
        <CHNAReportWidelyAvailableInd>1</CHNAReportWidelyAvailableInd>
        <RptAvailableOnOwnWebsiteInd>X</RptAvailableOnOwnWebsiteInd>
        <OwnWebsiteURLTxt>http://swhealthcare.net/events/chna.html</OwnWebsiteURLTxt>
        <OtherWebsiteInd>X</OtherWebsiteInd>
        <OtherWebsiteURLTxt>See Part V, Section C</OtherWebsiteURLTxt>
        <PaperCopyPublicInspectionInd>X</PaperCopyPublicInspectionInd>
        <ImplementationStrategyAdoptInd>1</ImplementationStrategyAdoptInd>
        <ImplementationStrategyAdptYr>22</ImplementationStrategyAdptYr>
        <StrategyPostedWebsiteInd>1</StrategyPostedWebsiteInd>
        <StrategyWebsiteURLTxt>http://swhealthcare.net/events/chna.html</StrategyWebsiteURLTxt>
        <OrganizationIncurExciseTaxInd>0</OrganizationIncurExciseTaxInd>
        <EligCriteriaExplainedInd>1</EligCriteriaExplainedInd>
        <FPGFamilyIncmLmtFreeDscntInd>X</FPGFamilyIncmLmtFreeDscntInd>
        <FPGFamilyIncmLmtFreeCarePct>100.000000000000</FPGFamilyIncmLmtFreeCarePct>
        <FPGFamilyIncmLmtDscntCarePct>200.000000000000</FPGFamilyIncmLmtDscntCarePct>
        <AssetLevelCriteriaInd>X</AssetLevelCriteriaInd>
        <MedicalIndigencyCriteriaInd>X</MedicalIndigencyCriteriaInd>
        <InsuranceStatusCriteriaInd>X</InsuranceStatusCriteriaInd>
        <UnderinsuranceStatCriteriaInd>X</UnderinsuranceStatCriteriaInd>
        <OtherCriteriaInd>X</OtherCriteriaInd>
        <ExplainedBasisInd>1</ExplainedBasisInd>
        <AppFinancialAsstExplnInd>1</AppFinancialAsstExplnInd>
        <DescribedInfoInd>X</DescribedInfoInd>
        <DescribedSuprtDocInd>X</DescribedSuprtDocInd>
        <ProvidedHospitalContactInd>X</ProvidedHospitalContactInd>
        <ProvidedNonprofitContactInd>X</ProvidedNonprofitContactInd>
        <IncludesPublicityMeasuresInd>1</IncludesPublicityMeasuresInd>
        <FAPAvailableOnWebsiteInd>X</FAPAvailableOnWebsiteInd>
        <FAPAvailableOnWebsiteURLTxt>See Part V, Section C</FAPAvailableOnWebsiteURLTxt>
        <FAPAppAvailableOnWebsiteInd>X</FAPAppAvailableOnWebsiteInd>
        <FAPAppAvailableOnWebsiteURLTxt>See Part V, Section C</FAPAppAvailableOnWebsiteURLTxt>
        <FAPSummaryOnWebsiteInd>X</FAPSummaryOnWebsiteInd>
        <FAPSummaryOnWebsiteURLTxt>See Part V, Section C</FAPSummaryOnWebsiteURLTxt>
        <FAPAvlblOnRequestNoChargeInd>X</FAPAvlblOnRequestNoChargeInd>
        <FAPAppAvlblOnRequestNoChrgInd>X</FAPAppAvlblOnRequestNoChrgInd>
        <FAPSumAvlblOnRequestNoChrgInd>X</FAPSumAvlblOnRequestNoChrgInd>
        <NotifiedFAPCopyBillDisplayInd>X</NotifiedFAPCopyBillDisplayInd>
        <CommuntityNotifiedFAPInd>X</CommuntityNotifiedFAPInd>
        <OtherPublicityInd>X</OtherPublicityInd>
        <FAPActionsOnNonpaymentInd>1</FAPActionsOnNonpaymentInd>
        <PermitNoActionsInd>X</PermitNoActionsInd>
        <CollectionActivitiesInd>0</CollectionActivitiesInd>
        <ProvidedWrittenNoticeInd>X</ProvidedWrittenNoticeInd>
        <MadeEffortOrallyNotifyInd>X</MadeEffortOrallyNotifyInd>
        <ProcessedFAPApplicationInd>X</ProcessedFAPApplicationInd>
        <MadePresumptiveEligDetermInd>X</MadePresumptiveEligDetermInd>
        <NondisEmergencyCarePolicyInd>1</NondisEmergencyCarePolicyInd>
        <LookBackMedicarePrivateInd>X</LookBackMedicarePrivateInd>
        <AmountsGenerallyBilledInd>0</AmountsGenerallyBilledInd>
        <GrossChargesInd>0</GrossChargesInd>
      </HospitalFcltyPoliciesPrctcGrp>
      <SupplementalInformationGrp>
        <FormAndLineReferenceDesc>Southwest Healthcare Services</FormAndLineReferenceDesc>
        <ExplanationTxt>Part V, Section B, Line 5: A service area survey was available to all residents. Community leaders were chosen to represent the broad interests of the community and took part in one-on-one informant interviews. A community group was formed comprised of community leaders and area residents, including representation from the health community, business community, law enforcement, education, faith community, and social services agencies. This community group met to discuss and prioritize area health needs during two separate group meetings.</ExplanationTxt>
      </SupplementalInformationGrp>
      <SupplementalInformationGrp>
        <FormAndLineReferenceDesc>Southwest Healthcare Services</FormAndLineReferenceDesc>
        <ExplanationTxt>Part V, Section B, Line 11: The organization completed a new CHNA in 2022. The top four needs identified were: Availability of mental health services; attracting and retaining young families; not enough healthcare staff in general; depression and anxiety (all ages)Southwest Healthcare Services will continue to work on implementing all top identified needs as outlined in our implementation plan. Note that we grouped availability of mental health services and depression/anxiety together in our implementation plan.Southwest Healthcare Services outpatient behavior health department is a program for our geriatric population that has been successful for our community, Using the Geriatric Depression Scale to assess the depressive symptoms in our older population, there was a decrease of 6.3 points on this scale for the second year in a row. In 2024, our behavior health department has as high as eight admissions and 24 referrals. We consider this a great victory for our older population.Our main shortage in healthcare staff remains in the nursing department for 2024. Contract staff has been a high expense for our facility, and we continue to research companies to stay competitive. We continue to offer a robust recruitment program that includes generous sign-on bonuses for several departments, student loan repayment, and relocation cost reimbursement. It has been a challenge to recruit to a rural hospital. However, Southwest Healthcare hired 33 employees in 2024, including a new Occupational Therapist. When Southwest Healthcare Services is recruiting a candidate that is not from the area, our administration collaborates with our economic development office and a town tour is given, along with resources that includes permanent and temporary housing options. Bowman's Economic Development have continued to build assets for are community to improve the quality of life, which helps retain employees. The Bowman Parks and Recreation have also helped attract young families by using their 1 percent city sales tax allocation to support the construction of a new rec center, that includes the areas first trampoline park along with revitalizing older parks and adding a splash pad.</ExplanationTxt>
      </SupplementalInformationGrp>
      <SupplementalInformationGrp>
        <FormAndLineReferenceDesc>Southwest Healthcare Services</FormAndLineReferenceDesc>
        <ExplanationTxt>Part V, Section B, Line 13h: The Organization uses a Soft credit check. Also presumptive eligibility may be used to determine eligibility for financial assistance based on the individuals life circumstances that may include: 1. State funded prescription programs;2. Homeless or received care from a homeless clinic;3. Participation in Women, Infants and Children programs (WIC);4. Food stamp eligibility;5. Subsidized school lunch program eligibility;6. Eligibility for other state or local assistance program that areunfunded (e.g. Medicaid spend-down);7. Low income/subsidized housing is provided as a valid address; and8. Patient is deceased with no known estate.</ExplanationTxt>
      </SupplementalInformationGrp>
      <SupplementalInformationGrp>
        <FormAndLineReferenceDesc>Southwest Healthcare Services</FormAndLineReferenceDesc>
        <ExplanationTxt>Part V, Section B, Line 16j: A summary of the financial assistance policy and financial assistance contact information can be found at the admissions desk in the hospital, clinic, and online. The financial assistance application is also summarized on the back of our billing invoices.</ExplanationTxt>
      </SupplementalInformationGrp>
      <SupplementalInformationGrp>
        <FormAndLineReferenceDesc>Part V, Section B, Line 7b:</FormAndLineReferenceDesc>
        <ExplanationTxt>http://swhealthcare.net/events/chna.html</ExplanationTxt>
      </SupplementalInformationGrp>
      <SupplementalInformationGrp>
        <FormAndLineReferenceDesc>Part V, Section B, Line 16a:</FormAndLineReferenceDesc>
        <ExplanationTxt>http://swhealthcare.net/patient/financials/financial-assistance-policy.html</ExplanationTxt>
      </SupplementalInformationGrp>
      <SupplementalInformationGrp>
        <FormAndLineReferenceDesc>Part V, Section B, Line 16b:</FormAndLineReferenceDesc>
        <ExplanationTxt>http://swhealthcare.net/patient/financials/financial_assistance_form.html</ExplanationTxt>
      </SupplementalInformationGrp>
      <SupplementalInformationGrp>
        <FormAndLineReferenceDesc>Part V, Section B, Line 16c:</FormAndLineReferenceDesc>
        <ExplanationTxt>http://swhealthcare.net/patient/financials/assistance.html</ExplanationTxt>
      </SupplementalInformationGrp>
      <FacilityNum>3</FacilityNum>
      <OthHlthCareFcltsNotHospitalGrp>
        <OthHlthCareFcltsGrp>
          <BusinessName>
            <BusinessNameLine1Txt>2 - Bowman Ambulance Services</BusinessNameLine1Txt>
          </BusinessName>
          <USAddress>
            <AddressLine1Txt>111 Highway 12 W</AddressLine1Txt>
            <CityNm>Bowman</CityNm>
            <StateAbbreviationCd>ND</StateAbbreviationCd>
            <ZIPCd>58623</ZIPCd>
          </USAddress>
          <FacilityTxt>Ambulance Services</FacilityTxt>
        </OthHlthCareFcltsGrp>
        <OthHlthCareFcltsGrp>
          <BusinessName>
            <BusinessNameLine1Txt>3 - Southwest Healthcare Services</BusinessNameLine1Txt>
          </BusinessName>
          <USAddress>
            <AddressLine1Txt>802 2nd St NW</AddressLine1Txt>
            <CityNm>Bowman</CityNm>
            <StateAbbreviationCd>ND</StateAbbreviationCd>
            <ZIPCd>58623</ZIPCd>
          </USAddress>
          <FacilityTxt>Independent Living and LTC</FacilityTxt>
        </OthHlthCareFcltsGrp>
        <OthHlthCareFcltsGrp>
          <BusinessName>
            <BusinessNameLine1Txt>4 - Sunrise Village</BusinessNameLine1Txt>
          </BusinessName>
          <USAddress>
            <AddressLine1Txt>203 11th Ave NW</AddressLine1Txt>
            <CityNm>Bowman</CityNm>
            <StateAbbreviationCd>ND</StateAbbreviationCd>
            <ZIPCd>58623</ZIPCd>
          </USAddress>
          <FacilityTxt>Assisted Living and Home Care</FacilityTxt>
        </OthHlthCareFcltsGrp>
      </OthHlthCareFcltsNotHospitalGrp>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Part I, Line 3c:</FormAndLineReferenceDesc>
        <ExplanationTxt>There are instances when a patient may appear eligible for financial assistance but the patient has failed to submit a Financial Assistance Application or an Application has been submitted but a proper determination cannot be made due to the lack of adequate information or supporting documentation. Often there is adequate information provided by the patient through other sources which could provide sufficient evidence to provide the patient with assistance. In the event there is no evidence to support a patient's eligibility for financial assistance, Southwest Healthcare Services could use outside agencies in determining estimated income amounts for the basis of determining financial assistance eligibility and potential discount amounts. Presumptive eligibility may be determined on the basis of individual life circumstances that may include:1. State funded prescription programs;2. Homeless or received care from a homeless clinic;3. Participation in Women, Infants and Children programs (WIC);4. Food stamp eligibility;5. Subsidized school lunch program eligibility;6. Eligibility for other state or local assistance program that are unfunded (e.g. Medicaid spend-down);7. Low income/subsidized housing is provided as a valid address; and8. Patient is deceased with no known estate.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Part I, Line 7:</FormAndLineReferenceDesc>
        <ExplanationTxt>Charity care expense was converted to cost on line 7a based on an overall cost-to-charge ratio addressing all patient segments. Community health improvement services, line 7e, are reported based on actual expenseamounts recorded from the events in the general ledger. The costs for Medicaid reported on line 7b were determined using the Medicaid Cost report and the cost for subsidized health services reported on line 7g were determined using the Medicare Cost Report.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Part II, Community Building Activities:</FormAndLineReferenceDesc>
        <ExplanationTxt>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.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Part III, Line 2:</FormAndLineReferenceDesc>
        <ExplanationTxt>The amount reported on line 2 represents implicit price concessions. Southwest determines its estimate of implicit price concessions based on its historical collection experience with this class of patients and residents.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Part III, Line 3:</FormAndLineReferenceDesc>
        <ExplanationTxt>Based on our review, it is safe to reasonably estimate that 20% of implicit price concessions is attributable to patients eligible under our charity care policy. If these individuals would have completed the paperwork required to obtain financial assistance, they may have qualified. Southwest Healthcare Services does not refuse service to patients that are unable to pay. This is evidence that the care is given for community benefit motivations.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Part III, Line 4:</FormAndLineReferenceDesc>
        <ExplanationTxt>The footnote to the Organization's financial statements can be found on page 12 and 13 of the attached audited financial statements.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Part III, Line 8:</FormAndLineReferenceDesc>
        <ExplanationTxt>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 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. Hospital services rendered on a fee schedule are not included in the Medicare calculation per the Form 990 instructions. Had this been reported the Hospital would have had a greater loss from Medicare services of $88,463.$45,185 - Medicare fee schedule revenue($133,648) - Medicare estimated costs of care relating to payments($88,463) - Net (shortage)</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Part III, Line 9b:</FormAndLineReferenceDesc>
        <ExplanationTxt>Southwest Healthcare Services will not engage in extraordinary collection actions (ECA) before it makes a reasonable effort to determine whether a patient is eligible for financial assistance.Reasonable efforts shall include:1. Validating that the patient owes the unpaid bills and that all sources of third party payment have been identified and billed by the hospital;2. Documentation that the patient has been offered a payment plan but has not honored the terms of that plan;3. Documentation that Southwest Healthcare Services has offered and has attempted to offer the patient the opportunity to apply for financial assistance and that the patient has not complied with the hospital's application requirements;4. Documentation that Southwest Healthcare Services has exerted efforts to notify patients about an impending ECA. These efforts should include:a. Providing patients with a 30-day written notice before initiating collection activities. This 30-day written notice shall include a copy of the Financial Assistance Policy Plain Language Summary;b. Making oral attempts to contact patients, using their contact information on file, about an impending ECA as well as informing patients about the availability of Southwest Healthcare's Financial Assistance Policy;5. Providing for a Notification Period of 120 days from the date of the first post-discharge billing statement during which Southwest Healthcare is required to notify the patient of the availability of FinancialAssistance. ECAs may only start after this Notification Period has elapsed and no Financial Assistance has been submitted by the patient;6. Providing for an Application Period of 240 days from the date of the first post-discharge billing statement during which Southwest Healthcare is required to accept and deliberate on a Financial Assistanceapplication that a patient may submit, while taking into consideration the following:a. If a patient submits an incomplete application during the Application Period, Southwest Healthcare must:i. Suspend any ECAs already initiated;ii. Inform the patient by way of a written notice what additional information or documentation is required;iii. Provide the contact information of the Financial Counselor who may assist the patient in completing the Financial Assistance application;If the patient fails to provide the additional information or documentation after 30 days from notification, Southwest Healthcare may resume ECAs.b. If a patient submits a complete application during the Application Period, Southwest Healthcare must:i. Suspend any ECAs already initiated;ii. Determine whether the application meets the eligibility criteria for Financial Assistance.iii. Inform the patients within 30 days by way of a written notice of the result of the determination and the basis for the decision.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Part VI, Line 2:</FormAndLineReferenceDesc>
        <ExplanationTxt>In addition to completing a Community Health Needs Assessment every 3 years, Southwest Healthcare assesses health care needs of the community in the following ways: Satisfaction surveys are sent to patients and residents. Our department heads get together once a month to discuss issues or opportunities within their departments. Certain department heads also meet with the Board of Directors to discuss their departments and community health needs within the community. Health fairs are held within our service area. If any feedback is given from patients attending the health fair, it is brought to the attention of the administrator.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Part VI, Line 3:</FormAndLineReferenceDesc>
        <ExplanationTxt>A summary of our financial assistance policy and financial assistance contact information can be found at the admissions desk in the hospital, clinic, online, and on the back of our statements. Financial assistance contact information is included in patient bills and is discussed with patients as well as the availability of various government benefits, such as Medicaid or state programs. Patients are assisted with qualification for such programs where applicable. Employees who are responsible for registering patients are asked to consider/screen patients who may appear to qualify or who have asked about financial assistance. The registration clerk is to give the patient a brochure explaining the Financial Assistance program which contains information on how to access the Patient Financial Services Representative (PFS) to obtain assistance.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Part VI, Line 4:</FormAndLineReferenceDesc>
        <ExplanationTxt>The community is largely agriculturally based but in recent years the oil and gas industry has grown extensively. The growth in the oil and gas industries has increased the patient base that our organization serves. 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 to have an unemployment rate in 2023 of 1.0% in Bowman County, 2.1% in Slope County and 2.1% in Harding County and a median income in 2021 of $69,437 for our service area. In 2023, approximately 29.2% of the persons under the age of 65 were without health insurance in our service area.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Part VI, Line 5:</FormAndLineReferenceDesc>
        <ExplanationTxt>Southwest Healthcare Services extends medical privileges to all providers in the community, and has a community board. Any surplus funds are used for investments in both capital assets, and medical equipment which improve services available as well as the quality of care that we give to the patients in our service area.Southwest Healthcare Services operates an emergency room available to all regardless of ability to pay. The Hospital participates in education and training of healthcare professionals and serves as a vehicle to attract and effectively use donated funds. Southwest Healthcare Services provides EMS staff support at public sporting events such as Motocross races, rodeos, and school sport activities. Support is also provided to the high school in the form of sports medicine for their sports activities. We do health fairs in 6 communities across our service area. We provide CPR and first aid classes to local coaches. We participate in job shadow events and career fairs.</ExplanationTxt>
      </SupplementalInformationDetail>
    </IRS990ScheduleH>
    <IRS990ScheduleJ documentId="RetDoc1042400001">
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      <IndependentConsultantInd>X</IndependentConsultantInd>
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        <PersonNm>Tim Adams</PersonNm>
        <TitleTxt>Physician</TitleTxt>
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        <TotalCompensationRltdOrgsAmt>0</TotalCompensationRltdOrgsAmt>
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      <RltdOrgOfficerTrstKeyEmplGrp>
        <PersonNm>Roy Cordy</PersonNm>
        <TitleTxt>Physician</TitleTxt>
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      </RltdOrgOfficerTrstKeyEmplGrp>
      <RltdOrgOfficerTrstKeyEmplGrp>
        <PersonNm>Dennis Goebel</PersonNm>
        <TitleTxt>CEO</TitleTxt>
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        <CompensationBasedOnRltdOrgsAmt>0</CompensationBasedOnRltdOrgsAmt>
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        <NontaxableBenefitsRltdOrgsAmt>0</NontaxableBenefitsRltdOrgsAmt>
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      <RltdOrgOfficerTrstKeyEmplGrp>
        <PersonNm>Christine Peterson NP full</PersonNm>
        <TitleTxt>year)/Trustee (Jan-Jun)</TitleTxt>
        <BaseCompensationFilingOrgAmt>185062</BaseCompensationFilingOrgAmt>
        <CompensationBasedOnRltdOrgsAmt>0</CompensationBasedOnRltdOrgsAmt>
        <BonusFilingOrganizationAmount>0</BonusFilingOrganizationAmount>
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        <NontaxableBenefitsFilingOrgAmt>9420</NontaxableBenefitsFilingOrgAmt>
        <NontaxableBenefitsRltdOrgsAmt>0</NontaxableBenefitsRltdOrgsAmt>
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        <TotalCompensationRltdOrgsAmt>0</TotalCompensationRltdOrgsAmt>
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      </RltdOrgOfficerTrstKeyEmplGrp>
      <RltdOrgOfficerTrstKeyEmplGrp>
        <PersonNm>Amanda Loughman</PersonNm>
        <TitleTxt>CFO</TitleTxt>
        <BaseCompensationFilingOrgAmt>129931</BaseCompensationFilingOrgAmt>
        <CompensationBasedOnRltdOrgsAmt>0</CompensationBasedOnRltdOrgsAmt>
        <BonusFilingOrganizationAmount>0</BonusFilingOrganizationAmount>
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        <TotalCompensationFilingOrgAmt>153699</TotalCompensationFilingOrgAmt>
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    <IRS990ScheduleL documentId="RetDoc1042800001">
      <BusTrInvolveInterestedPrsnGrp>
        <NameOfInterested>
          <PersonNm>Jason Anderson</PersonNm>
        </NameOfInterested>
        <RelationshipDescriptionTxt>Jason is the brother of Board Member Jordan Anderson</RelationshipDescriptionTxt>
        <TransactionAmt>56870</TransactionAmt>
        <TransactionDesc>Compensation</TransactionDesc>
        <SharingOfRevenuesInd>0</SharingOfRevenuesInd>
      </BusTrInvolveInterestedPrsnGrp>
      <BusTrInvolveInterestedPrsnGrp>
        <NameOfInterested>
          <PersonNm>Amber Anderson</PersonNm>
        </NameOfInterested>
        <RelationshipDescriptionTxt>Amber is the wife of Board Member Jordan Anderson</RelationshipDescriptionTxt>
        <TransactionAmt>51072</TransactionAmt>
        <TransactionDesc>Compensation</TransactionDesc>
        <SharingOfRevenuesInd>0</SharingOfRevenuesInd>
      </BusTrInvolveInterestedPrsnGrp>
    </IRS990ScheduleL>
    <IRS990ScheduleO documentId="RetDoc1044400001">
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VI, Section A, line 1a</FormAndLineReferenceDesc>
        <ExplanationTxt>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.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VI, Section A, line 8b</FormAndLineReferenceDesc>
        <ExplanationTxt>The Organization has an Executive Committee, however no action was taken. Recommendations were taken to the full board of directors.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VI, Section B, line 11b</FormAndLineReferenceDesc>
        <ExplanationTxt>The return is reviewed by the CFO during the process of completing the return. Once a draft is completed, a copy is distributed to the CEO and emailed to the Board of Directors prior to filing.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VI, Section B, line 12c</FormAndLineReferenceDesc>
        <ExplanationTxt>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.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VI, Section B, line 15</FormAndLineReferenceDesc>
        <ExplanationTxt>The CEO's performance review is completed by the Executive Team of the Board of Directors, comprised of the President, Vice President, and Secretary. In 2023, the CEO brought data from the North Dakota Compensation Salary Survey as well as an independent study completed by Eide Bailly. The CFO also compiled other CEO wages from comparable North Dakota Critical Access Hospitals using publicly reported 990 data. The CEO made a recommendation of where his salary range should be based on years in his role and beforementioned data. In 2024 a 3% increase was given to the CEO similar to other staff. In 2023, the CEO brought a recommendation a one-time market increase for the CFO based on the North Dakota Compensation Salary Survey and her years of comparable service. A 3% increase was given to the CFO in 2024 similar to other staff.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VI, Section C, line 19</FormAndLineReferenceDesc>
        <ExplanationTxt>The Organization makes its governing documents, conflict of interest policy, and financial statements available to the public upon request.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part IX, line 11g</FormAndLineReferenceDesc>
        <ExplanationTxt>Repairs, Maintenance and Service Contracts and Fees: Program service expenses 489,592. Management and general expenses 677,642. Fundraising expenses 0. Total expenses 1,167,234. Purchased services &amp; recruitment: Program service expenses 335,557. Management and general expenses 69,323. Fundraising expenses 0. Total expenses 404,880. Professional Fees &amp; Consulting: Program service expenses 4,505,300. Management and general expenses 73,338. Fundraising expenses 0. Total expenses 4,578,638.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part XI, line 9:</FormAndLineReferenceDesc>
        <ExplanationTxt>Auxiliary Net Income 5,528. Change in Sunrise Receivable 193,354.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>AMENDED RETURN</FormAndLineReferenceDesc>
        <ExplanationTxt>The Tax Return has been amended to tie to the audited financial statements. The original return was prepared using draft financial statements. The final audited financial statements have been attached to the amended return. The following parts of the return were changed: Part I: Current year numbers changed to reflect changes in other parts of the return. Part III, line 4a: Program revenues were adjusted to match final audit figures. Part IV, line 11f and 12a: Updated to indicate audited financial statements were obtained. Part VIII, line 2a and 12: Updated to match final audit figures. Part X, line 4,16, 27, 32, and 33: Updated to match final audit figures. Part XI, line 1,3, and 10: Updated for changes to numbers reflected in other parts of the return. Part XII, line 2b and 2c: Updated to indicate audited financial statements were obtained. Schedule D, part XI, XII and XIII: Updated to match final audit figures and to reconcile the tax return to the final audit. Schedule H, part III, line 2 and 3: Updated to match final audit figures.</ExplanationTxt>
      </SupplementalInformationDetail>
    </IRS990ScheduleO>
  </ReturnData>
</Return>