2024-04-30T15:46:48-05:00 2023-06-30 450250958 Eide Bailly LLP 800 Nicollet Mall Ste 1300 Minneapolis MN 554027033 990 2022-07-01 450447670 Mountrail County Medical Center MOUN 7016282424 615 6th Street SE Stanley ND 58784 Eugeniya Griffin CFO 7016282424 2024-04-26 1 Eugeniya Griffin 999009999 1 Kim Hunwardsen CPA P00484560 6122536500 2024-04-26 2 AAL1 IAL1 2022 2023-04-26 12:10:37Z Stephanie Everett 615 6th Street SE Stanley ND 58784 11312063 0 X www.stanleyhealth.org X 1997 ND Provision of medical services to the residents of Stanley, ND. 5 5 8 7 -989 0 730788 1185191 8185489 10020696 25460 68057 -33936 11621 8907801 11285565 0 0 0 0 1477376 1723523 0 0 0 6544064 7369218 8021440 9092741 886361 2192824 10519093 14647882 1950946 3886911 8568147 10760971 X Mountrail County Medical Center will provide quality health care services to Mountrail County and the surrounding area including: primary medical care, emergency care, swing bed and clinic services. 1 0 7417702 10020696 Mountrail County Medical Center is an 11-bed acute care hospital and clinic which promotes the health of the community by providing a variety of health services.Mountrail County Medical Center has taken steps to enhance preventative care for people of all ages through the development of guidelines to ensure that those who come here for preventative care receive the screenings and recommendations appropriate to their personal and family history. The hospital provided 132 acute care days, 481 swing bed days, and 21 observation days during the fiscal year 2023. Statement continued on Schedule O.Mountrail County Medical Center had 95 admissions (50 acute, 27 swing bed, 18 observation), and 3,003 emergency visits (378 outpatient and 2,625 ED patients).The Medical Center provides healthcare services to patients who meet certain criteria under its charity care policy without charge or at amounts less than established rates. Since the Medical Center does not pursue collection of these amounts, they are not reported as patient service revenue. The estimated cost of providing these services was $61,000 for the year ended June 30, 2023, calculated by multiplying the ratio of cost to gross charges for the Medical Center by the gross uncompensated charges associated with providing charity care to its patients. 7417702 1 1 0 0 0 0 0 0 0 0 1 0 0 1 1 1 1 0 0 0 0 0 0 0 0 0 1 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 8 0 1 8 1 1 1 0 0 0 0 0 0 0 0 0 0 0 X 5 5 1 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 0 0 0 X Eugeniya Griffin 7016282424 PO Box 399 Stanley ND 58784 X Heath Hetzel President (Jul-Nov) 1.00 X X 0 0 0 Ryan Gjellstad President starting Nov 1.00 X X 0 0 0 Tom Warsocki Vice President 1.00 X X 0 0 0 John Anderson Secretary/Treasurer 1.00 X X 0 0 0 Rhonda Johnson Director 1.00 X 0 0 0 Mike Sorenson Director 1.00 X 0 0 0 Ray Schepp Director (Jul-Nov) 1.00 X 0 0 0 Stephanie Everett CEO/Administrator 20.00 X 220271 0 30127 Megan Buee CFO 20.00 X 85664 0 3427 Mark Longmuir MD Family Medicine/Chief of Staff 40.00 X 304783 0 39217 Jessica Charon DNP FNP-C Doctor of Nursing Practice 40.00 X 176738 0 34095 Tara Nardacci DNP Family Nurse Practitioner 40.00 X 168055 0 33748 Tammie Braaflat FNP-C Family Nurse Practitioner 40.00 X 159171 0 33393 Abbey Ruland PA Physician Assistant 40.00 X 154882 0 38221 1269564 0 212228 8 0 0 1 Mountrail Bethel Home Inc PO Box 700 Stanley ND 58784 Purchased services 4090000 EAPC 3100 Demers Ave Grand Forks ND 58201 Architect Fees 374808 Fiber Staffing 3811 Turtle Creek Blvd Suite 850 Dallas TX 75219 Contracted physical therapists 154213 Trinity Health 1 Burdick Expy Minot ND 58702 Software maintenance, HIM contracted ser 140365 DMS Health Technologies PO Box 670747 Dallas TX 752670747 MRI Services 124020 6 179844 1005347 1185191 Patient Service Revenue 621400 9132579 9132579 Sales Tax Revenue 900099 448580 448580 Pharmacy Revenue 621400 356653 356653 82884 82884 10020696 68057 68057 38119 26498 11621 11621 -989 12610 11285565 10020696 -989 80667 X 1393043 1393043 53993 53993 186674 186674 89813 89813 19544 19544 73387 73387 5128597 3903138 1225459 46495 46495 48795 48795 50110 10302 39808 221792 221792 38571 9278 29293 117259 107297 9962 581411 540936 40475 80747 80747 Medical Supplies 782039 782039 Equipment Rental 88060 86993 1067 Employee Education 48695 32404 16291 43716 43716 9092741 7417702 1675039 0 500 519 4229454 2113426 1861300 2046158 77585 85310 70926 75715 9071095 4526270 4279328 4544825 3687492 0 2094437 10519093 14647882 172555 184171 10391 10391 1362609 1212158 405391 2480191 1950946 3886911 X 8464460 10657284 103687 103687 8568147 10760971 10519093 14647882 2192824 0 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 25000 25000 379467 114410 265057 4445581 1911589 2533992 3469166 2500271 968895 751881 751881 4544825 Finance Lease ROU Assets 2094437 2094437 Trinity Health payable 227727 Estimated third-party payor settlements 29339 Mountrail Bethel Home payable 95774 Finance Lease Liabilities 2127351 2480191 X 11312063 0 11312063 -26498 -26498 11285565 9119239 26498 26498 9092741 0 9092741 Part X, Line 2: The Medical Center believes that it has appropriate support for any tax position taken affecting its annual filing requirements, and as such, does not have any uncertain tax positions that are material to the financial statements. The Medical Center 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. Part XI, Line 4b - Other Adjustments: Rental Expenses included in revenue for Form 990 -26,498. Part XII, Line 2d - Other Adjustments: Rental expenses included in revenue for Form 990 26,498. 1 1 X 1 X 1 X 1 1 1 0 0 61000 61000 0.00670 468924 447250 21674 0.00240 529924 447250 82674 0.00910 529924 447250 82674 0.00910 1 842778 210695 2850006 2857046 -7040 X 1 1 1 1 Mountrail County Medical Center 615 6th Street SE Stanley ND 58784 www.stanleyhealth.org 5047 X X X X Provider based rural health clinic Mountrail County Medical Center 1 0 0 1 X X X X X X X X X 21 1 0 0 1 X www.stanleyhealth.org/resources X 1 21 1 www.stanleyhealth.org/resources 0 1 X 100.000000000000 250.000000000000 X X X 1 1 X X X 1 X www.stanleyhealth.org/resources X www.stanleyhealth.org/resources X www.stanleyhealth.org/resources X X X X X X 1 X 0 X X X X 1 X 0 0 Mountrail County Medical Center Part V, Section B, Line 5: A community group, consisting of 12 community members, was convened and first met via Zoom on November 1, 2021. During this first community group meeting, group members were introduced to the needs assessment process, reviewed basic demographic information about the community, and served as a focus group. Focus group topics included community assets and challenges, the general health needs of the community, community concerns, and suggestions for improving the community's health. The community group met again virtually on December 15, 2021, with 14 community members in attendance. At this second meeting, the community group was presented with survey results, findings from key informant interviews and the focus group, and a wide range of secondary data, relating to the general health of the population in Mountrail County. The group was then tasked with identifying and prioritizing the community's health needs.One-on-one interviews with four key informants were conducted virtually via Zoom on November 1, 2021. A representative from CRH conducted the interviews. Interviews were held with selected members of the community who could provide insights into the community's health needs. Included among the informants were public health professionals with special knowledge in public health, acquired through several years of direct experience in the community, including working with medically underserved, low income, and minority populations, as well as with populations with chronic diseases.A survey was distributed to solicit feedback from the community and was not intended to be a scientific or statistically valid sampling of the population. It was designed to be an additional tool for collecting qualitative data from the community at large specifically, information related to community-perceived health needs. Mountrail County Medical Center Part V, Section B, Line 11: The 2021 Community Health Needs Assessment (CHNA) was completed during fiscal year 2022. The top needs identified were: 1. Alcohol use and abuse for all ages 2. Depression/anxiety 3. Attracting and retaining young families 4. Having enough child daycare servicesAlcohol Use and Abuse For All AgesObjective: Work closely with local agencies such as the Upper Missouri District Health Unit and the local social services along with the MCMC ER to see how we can help patients that come in again and again for alcohol issues.GOAL: As stated above, help patients that frequently visit the ER due to alcohol abuse over the next year.Strategy:-Compiled a brochure that shows all the services that can help these patients once they leave the ER.-Worked closely with UMDHU and their addiction counselor.-Worked closely with Stanley's local AA group and even offer them a space in the clinic to meet.-Held Skittle Skool III again on December 9th, 2022 with speakers addressing Alcohol Use and Abuse.Measurements of Effectiveness: Staff worked together to reduce the frequency of alcohol abuse visits to our own ER.Depression and AnxietyObjective: Bring in a much needed service to our County. We will address it within our Medical Center for our county as a whole and also our youth at the schools.GOAL: To take care of our own with the Mental Health issue at hand. Rural ND is treated differently than urban ND. And we need to fix this. We need to be a part of a village treating Mental Health. We need to train our kids to have more self confidence in themselves and have resiliency. We need to train our local Providers to treat Mental Health as a disease and not a stigma. We need to provide professional Mental Health Services to our County. And we need to focus on the employees of Mountrail County Medical Center.Strategy:-The Dare to Define YOU youth leadership program was started in New Town and Stanley for the school year 2019/2020 and still continues into this school year in Stanley. With this program we are addressing the Mental Health issue with the children and their parents by helping them with skill building; leadership is having a developed sense of who you are, what you can do, where you are going and the ability to influence communication, emotions and behavior on the way to getting there. We have found that when we become leaders, together lives are transformed.-Continued to work with the SHS Administration to identify at risk children and the Mountrail County Health Foundation helps fund needs for these children to receive help.-Skittle Skool III was held again on December 9th, 2022. Teen Mental Health speaker Jeff Vaiden was one of the presenters at Skittle Skool this year.-Worked with Psychiatric Medical Care to bring in Mental Health Professionals to our patients and also a local Provider that will work with our patients, students at the school and the CountySocial Services.-A new focus will be on the employees of MCMC. COVID brought us to our knees. And we need to focus on our staff more than ever. Worked with the creator of Dare to Define YOU and the creator of Profound Growth to create a program tailored to us to build a culture and attitude in our building that "harnesses science and spirit for sustainable abundance."Attracting and Retaining Young FamiliesMountrail County Medical Center is always concerned with and recognizes the importance of growth in a community. However, MCMC is unable to fully address the issue of attracting and retaining young families to the area. While we are one of the largest employers, we have not been able to recruit employees with young families due to the limited resources in the area. While we cannot address this need, we can start working with the local City Council in possibly hiring an Economic Development Coordinator that could spur local growth that would attract young families.Having Enough Child Daycare ServicesObjective: After our Phase Three expansion of the Nursing Home is complete, we will evaluate our facility and see if there is an area we can remodel into an on-site daycare for MCMC employees. This will not only fill a huge need in the community but be a recruiting tool.GOAL: We will aim to have this CHNA need addressed within our three-year CHNA timeframe.Strategy:-Determine if we have the space for an on-site daycare.-Write a plan on how this on-site daycare can be accessible to employees' children as an employee benefit.-Explore grant options and opportunities that could help fund this daycare.Measurements of Effectiveness: To be able to accommodate the growing need for affordable daycare for our employees; we are one of the largest employers in our service area. Mountrail County Medical Center Part V, Section B, Line 13h: The following factors will also be considered in determining the eligibility for financial assistance:1. Employment status 2. Future earning capacity3. Other financial obligations Mountrail County Medical Center Part V, Section B, Line 16j: In correspondence sent to patients it is encouraged to inquire about the financial assistance policy. Part I, Line 3c: The following factors will also be considered in determining the eligibility for financial assistance:1. Employment status 2. Future earning capacity3. Other financial obligations Part I, Line 7: Charity care expense was converted to cost on line 7a based on an overall cost to charge ratio addressing all patient segments. Unreimbursed Medicaid on line 7b was calculated using the costing methods to prepare the cost report. Part III, Line 2: The amount on line 2 represents implicit price concessions. The Hospital determines its estimate of implicit price concessions based on its historical collection experience with this class of patients. Part III, Line 3: Approximately 25% of the Hospital's implicit price concession is attributable to patients eligible under the Organization's financial assistance policy. This is the approximate percentage of applications denied or not returned due to insufficient information. Part III, Line 4: The footnote to the Organization's financial statements can be found on pages 9-10 of the attached audited financial statements. Part III, Line 8: Mountrail County Medical Center is an acute care hospital providing Medicare services to patients knowing they will not recover all the costs associated with providing these services. Providing these services is essential to these patients therefore the Medicare shortfall is considered a community benefit. Both the total revenue received from Medicare and the Medicare allowable costs are reported 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. Part III, Line 9b: While a financial assistance application is pending final eligibility determination, Mountrail County Medical Center will not initiate collection efforts or requests for deposits, provided the responsible party is cooperative with Mountrail County Medical Center's efforts to reach a determination. The financial assistance approval can be extended up to a maximum of six months from the approval date to cover future qualified care or services and will consider balances on services which occurred within the last 240 days only. Part VI, Line 2: The Medical Center continues to access the health needs of the community by involvement in community organizations and physicians seeing patients on a daily basis. Part VI, Line 3: Mountrail County Medical Center has conspicuous public displays that notify and inform patients about the financial assistance program. Such displays are located in the emergency room and all admissions areas. Such displays include the following information:a. A statement that Mountrail County Medical Center offers financial assistance to eligible individuals. b. Information about how or where to obtain information about the Mountrail County Medical Center Financial Assistance Policy and application process. Mountrail County Medical Center will offer a paper copy of the Plain Language Summary of this Financial Assistance Policy to patients as part of the intake and/or discharge process.Mountrail County Medical Center will include the following information on all billing statements:a. Financial assistance is available under the Mountrail County Medical Center Financial Assistance Policy.b. The telephone number of a Mountrail County Medical Center office or department that can provide information about the Mountrail County Medical Center Financial Assistance Policy and process.c. The direct website address (http://www.stanleyhealth.org/resources) on which this Mountrail County Medical Center Financial Assistance Policy, a Plain Language Summary of this policy, and the Financial Assistance Application are available.Paper copies of this Financial Assistance Policy, a Plain Language Summary, and the Financial Assistance Application are available upon request and without charge. These paper copies are available by mail, in Mountrail County Medical Center's emergency room, and all other admissions areas of Mountrail County Medical Center. Part VI, Line 4: Mountrail County Medical Center is an acute care hospital located in northwest North Dakota, approximately 60 miles west of Minot. The city is mainly dependent on agriculture and oil as sources of economic stability. With nearly 130 employees, MCMC/MBH is one of the largest employers in Stanley. As of 2022, the population of Stanley was 2,189 with the county population being 9,241. The estimated median Stanley household income in 2022 was $101,351. The Mountrail County unemployment rate in 2022 was 1.1% compared to 2.1% in the state of North Dakota. The percentage of county residents with income below the poverty level in 2022 was 10.1%. Part VI, Line 5: Mountrail County Medical Center is an 11-bed acute care hospital with an emergency room and provider based rural health clinic. MCMC provides comprehensive medical care with physician and mid-level medical providers and consulting/visiting medical providers. MCMC has one Physician, three Physician Assistants, four Family Nurse Practitioner, and 13 nurses for a combined total of 21 healthcare providers.Mountrail County Medical Center is the community's sole provider and has an emergency room available 24/7 to all regardless of their ability to pay. 0 0 0 1 0 0 0 0 0 Mark Longmuir MD Family Medicine/Chief of Staff 304219 0 0 0 564 0 12191 0 27305 0 344279 0 0 0 Stephanie Everett CEO/Administrator 218430 0 800 0 1041 0 8811 0 21596 0 250678 0 0 0 Jessica Charon DNP FNP-C Doctor of Nursing Practice 176738 0 0 0 0 0 7070 0 27305 0 211113 0 0 0 Tara Nardacci DNP Family Nurse Practitioner 167937 0 0 0 118 0 6722 0 27305 0 202082 0 0 0 Abbey Ruland PA Physician Assistant 154647 0 0 0 235 0 6195 0 32305 0 193382 0 0 0 Tammie Braaflat FNP-C Family Nurse Practitioner 158919 0 0 0 252 0 6367 0 27305 0 192843 0 0 0 Part I, Line 5 Providers receive an RVU bonus based on any additional RVU over the median MGMA standards by discipline level and adjusted for the FTE. Form 990, Schedule J, Part II: Stephanie Everett, CEO/Administrator, is compensated by Mountrail Bethel Home, an unrelated organization, for services to Mountrail County Medical Center and Mountrail County Bethel Home. Compensation shown on Part VII of the 990 is calendar year 2022 compensation that was paid by Mountrail Bethel Home. Megan Buee, CFO, is compensated by Mountrail Bethel Home, an unrelated organization, for services to Mountrail County Medical Center and Mountrail County Bethel Home. Compensation shown on Part VII of the 990 is calendar year 2022 compensation that was paid by Mountrail Bethel Home. Form 990, Part III, line 2 Implementation of CCM program (Chronic Care Management) started in June 2023. Form 990, Part VI, Section A, line 1a The Board of Directors may designate three of its members (one Bethel appointee, one Trinity appointee, and one community representative) as an Executive Committee, which, to the extent determined by the board and permitted by law shall have and exercise the authority of the board in the management of the business of the corporation. The Executive Committee shall act only in the intervals between meetings of the board and shall at all times be subject to the control and direction of the board. A majority of the Executive Committee shall constitute a quorum for the transaction of any business. Form 990, Part VI, Section A, line 2 Heath Hetzel and John Anderson have a business relationship. Form 990, Part VI, Section A, line 6 Mountrail Bethel Home, Inc. and Trinity Health are the sole members of this corporation. The Board of Directors may not terminate, modify, or in any way curtail the membership rights of Mountrail Bethel Home, Inc. or Trinity Health. Form 990, Part VI, Section A, line 7a The Members, Mountrail Bethel Home and Trinity Health Center, have the power to appoint the Board of Directors and remove any director at any time. Bethel Home and Trinity each appoint two directors to the board. The four designated board members appoint two members from the service area of Mountrail County Medical Center. Form 990, Part VI, Section A, line 7b The following items are member reserved powers: A. The right to approve any amendments to the articles of incorporation or the bylaws. B. The right to approve the selection of auditors and legal counsel. C. The right to approve any budgets or strategic plans adopted. D. The right to approve any unbudgeted borrowing, any encumbrance of assets, and any expenditures for capital improvements where the amount exceeds 5% of the capital budget previously approved by the member. E. The right to change the number of directors of the board of directors. F. The right to approve any action of the corporation that is not in the ordinary course of the corporation's business. G. The right to dissolve or discontinue the operations of the corporation. The board is to promptly inform the member in writing of the board's intent to take any action over which the member has the right to approval. No such action shall become final or binding on the corporation until such time as the member has given the board its written approval of the action. The member must indicate its approval or disapproval in writing within thirty days of its receipt of such a notice. Form 990, Part VI, Section B, line 11b The governing body receives a copy of the 990 by email prior to the 990 being filed. The 990 is reviewed by the CFO and CEO. Form 990, Part VI, Section B, line 12c The board members and officers sign a conflict of interest policy annually. The board members and officers are responsible for bringing up potential conflicts of interest. Board members will abstain from voting on issues where there might be a conflict. Form 990, Part VI, Section C, line 19 The Organization's governing documents, conflict of interest policy and financial statements are available to the public upon request. Form 990, Part VII: The compensation reported in Part VII for the CEO/Administrator and CFO is total compensation for services provided to Mountrail County Medical Center and Mountrail Bethel Home. Mountrail Bethel Home is not considered a related organization, therefore hours for services to Bethel Home are not included on Part VII. Form 990, Part IX, line 11g Purchased Services: Program service expenses 3,572,993. Management and general expenses 1,129,999. Fundraising expenses 0. Total expenses 4,702,992. Contract Fees: Program service expenses 98,770. Management and general expenses 163. Fundraising expenses 0. Total expenses 98,933. Collection Fees: Program service expenses 10,696. Management and general expenses 60,972. Fundraising expenses 0. Total expenses 71,668. Outside Fees: Program service expenses 220,679. Management and general expenses 0. Fundraising expenses 0. Total expenses 220,679. Professional Fees: Program service expenses 0. Management and general expenses 34,325. Fundraising expenses 0. Total expenses 34,325.