2024-06-04T08:47:37-05:00 2022-06-30 450250958 Eide Bailly LLP 1730 Burnt Boat Loop Ste 100 Bismarck ND 585030886 990 2021-07-01 450227753 Cooperstown Medical Center COOP 7017972221 1200 Roberts Avenue NE Cooperstown ND 58425 Judy Monson Chief Financial Officer 7017972221 2024-06-04 1 Judy Monson 999009999 Lisa Chaffee CPA P00193453 7012551091 2024-06-04 3 AAL1 IAL1 2021 2023-04-26 12:10:37Z X Dakota Regional Medical Center Judy Monson 1200 Roberts Avenue NE Cooperstown ND 58425 5625826 0 X https://www.dakotaregional.com/ X 1946 ND Provide health care services to the residents including the elderly in the Cooperstown, North Dakota and surrounding communities regardless of the ability to pay. 5 5 52 5 0 0 3197011 636654 4966229 5189592 -3195 2592 5022 -625520 8165067 5203318 0 11189 0 0 3067259 3031582 0 0 0 1877144 2086479 4944403 5129250 3220664 74068 7539449 20947350 3952630 17286463 3586819 3660887 Cooperstown Medical Center is dedicated to providing high quality healthcare services in a personalized, compassionate, and professional manner. 0 0 4061259 11189 4562032 An 18-bed critical access hospital is privately located on the second floor of the facility. Helping to relieve the added stress of extended travel, the organization is able to provide locally many of the services found at large hospitals. Through strong affiliations with major medical organizations, Cooperstown Medical Center is able to provide: 24-hour emergency services, occupational therapy, x-ray and laboratory services, electrocardiography, respiratory therapy, incontinence management, therapy, physical therapy, speech therapy, cardiac monitoring/telemetry, chemotherapy, swing bed, and hospice care. The hospital had 189 total inpatient days. 4061259 1 1 0 0 0 0 0 0 1 0 1 0 0 0 1 1 0 1 0 0 0 0 0 0 0 0 1 1 0 0 1 0 0 0 0 0 0 1 0 0 0 0 0 0 1 1 0 0 0 1 13 0 1 52 1 0 0 0 0 0 0 0 0 0 0 0 0 X 5 5 1 0 0 0 1 1 0 1 1 0 0 1 1 1 1 1 1 1 1 0 X Judy Monson 7017972221 1200 Roberts Ave NE Cooperstown ND 58425 Barry Getz President 1.00 0.00 X X 0 0 0 James Halvorson Director 1.00 1.00 X 0 0 0 Larry Grandalen Director 1.00 0.00 X 0 0 0 Endre Aarestad Director 1.00 0.00 X 0 0 0 Torry Reutter Director 1.00 0.00 X 0 0 0 Nicole Lindsey CEO - Administrator 12.00 40.00 X 48892 0 8050 Barbara Anderson CFO 40.00 12.00 X 103308 0 1861 Steven Barlow Mid-Level/Nurse Practioner 40.00 0.00 X 290121 0 36708 Debra Middleton Mid-Level/Nurse Practition 40.00 0.00 X 246544 0 15548 Larissa Haug PA 40.00 0.00 X 180341 0 40711 869206 0 102878 4 0 1 1 HGFA Architect 222 N 32nd Street Suite 800 Billings MT 59101 Architect for new hospital 598771 1 609638 27016 636654 Net Patient and Reside 623000 4765596 4765596 Assisted Living Rental 623000 231753 231753 192243 192243 5189592 2592 2592 424548 422508 2040 2040 2040 PRF Contribution 900099 -627560 -627560 -627560 5203318 4562032 0 4632 X 11189 11189 169180 169180 28000 28000 2354055 2037804 316251 62071 50141 11930 251747 204164 47583 166529 134521 32008 58321 30 58291 996898 779439 217459 22024 6312 15712 243567 204748 38819 1868 1868 136337 118533 17804 29277 27932 1345 16937 13878 3059 1603 1603 163321 146274 17047 45861 1459 44402 Medical Supplies 249423 249423 Dues and Subscriptions 58518 31133 27385 Repairs and Maintenance 38153 38153 24371 6126 18245 5129250 4061259 1067991 0 1855461 2094290 500000 730231 972597 124176 117081 67343 57686 24869000 8224921 3576721 16644079 1078517 561617 107000 0 7539449 20947350 1029440 2715130 149461 777021 25912 25000 2530067 12938939 217750 830373 3952630 17286463 X 3086819 3160887 500000 500000 3586819 3660887 7539449 20947350 74068 0 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 1 X 133277 133277 6112047 6045088 66959 3077655 2025220 1052435 15546021 154613 15391408 16644079 Related Party Payable 245193 Interest Payable 34180 Estimated Third Party Payor Settlements 551000 830373 X 5625826 0 5625826 -422508 -422508 5203318 5551758 422508 422508 5129250 0 5129250 Part IV, Line 2b: Security deposits advanced by tenants of the assisted living units are held in trust by the Organization. These funds are included in cash and cash equivalents and accounts payable in the consolidated financial statements. Tenant security deposits totaled $25,000 and $25,912 at June 30, 2022 and 2021. Part X, Line 2: The Medical Center believes that it has appropriate support for any tax positions taken affecting the annual filing requirements, and as such, does not have any uncertain tax positions that are material to the consolidated 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 Tax return -422,508. Part XII, Line 2d - Other Adjustments: Rental Expenses included in Revenue for tax return 422,508. 1 1 X 1 X 1 X 1 0 0 17000 17000 0.00330 313799 289339 24460 0.00480 330799 289339 41460 0.00810 931994 649858 282136 0.05500 931994 649858 282136 0.05500 1262793 939197 323596 0.06310 1 120376 39724 2727362 2693973 33389 X 1 1 1 1 Cooperstown Medical Center 1200 Roberts Ave NE Cooperstown ND 58425 www.coopermc.com 5010 X X X Cooperstown Medical Center 1 0 0 1 X X X X X X X X X 21 1 0 0 1 X https://www.dakotaregional.com/about-7 X 1 21 1 https://www.dakotaregional.com/about-7 0 1 X 100.000000000000 200.000000000000 1 1 X X X X 1 X https://www.dakotaregional.com/about-7 X https://www.dakotaregional.com/about-7 X https://www.dakotaregional.com/about-7 X X X X X 1 X 0 X X X X 1 X 0 0 Cooperstown Medical Center Part V, Section B, Line 5: To gather feedback from the community, residents of the area were given the opportunity to participate in a survey. Seventy-five CMC service area residents completed the survey. Additional information was collected through five key informant interviews with community members. The input from the residents, who primarily reside in Griggs County, represented the broad interests of the communities in the service area. Together with secondary data gathered from a wide range of sources, the survey presents a snapshot of the health needs and concerns in the community. A community group met on March 28, 2022. Twelve community members attended the meeting. Cooperstown Medical Center Part V, Section B, Line 11: The community members voted on the needs identified to determine the ones deemed most significant. The needs were ranked as follows:1. Attracting and retaining young families2. Having enough child daycare services3. Availability of mental health services4. Depression and anxiety for all agesThe Hospital will not address the following health needs identified in the CHNA as part of this Implementation Plan due to limited resources and the need to allocate significant resources to the two priority health needs identified above. Ensure those community members' basic needs of care are met:1. Attracting and retaining young families.2. Adequate childcare services.Due to the timing of when the CHNA was completed, our implementation plan will begin to address the needs in more detail in FY23, however because the needs identified were similar to our previous CHNA, there were some things done already during the fiscal year that will help to address the needs identified.We added two mental health professionals and so we now have mental health services available two times a week with varying services. A couple service providers are also able to prescribe medicine and one provides therapy.Because childcare services were identified as a need on the assessment internal and external conversations occurred on the possibility of addressing this need but did not work out. Part I, Line 7: Charity care expense was converted to cost on line 7a based on an overall cost-to-charge ratio addressing all patient segments. Unreimbursed Medicaid on line 7b was calculated using the costing methods to prepare the cost reports. The cost for subsidized health services reported on line 7g was determined using the Medicare Cost Report. Part II, Community Building Activities: The Organization participates in community building activities, however, the activities are too difficult to quantify and are not tracked. Part III, Line 2: The amount on line 2 represents implicit price concessions. The Organization determines its estimate of implicit price concession based on its historical collection experience with this class of patients. Part III, Line 3: CMC used the percentage of charity care/financial assistance applications that were denied due to lack of sufficient information or were never returned to determine the amount of implicit price concessions that is attributable to patients who would likely qualify for charity. For FY 2022 approximately 33% of applications lacked information or were never returned after patient was given an application to complete. Part III, Line 4: The footnote to the Organization's financial statements can be found on pages 13 and 14 of the attached audited financial statements. Part III, Line 8: 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 Centers for Medicare and Medicaid Services. Part III, Line 9b: When patients are known to qualify for financial assistance, they are requested to fill out a financial assistance application and collection actions are stopped. If an application is returned with insufficient information a telephone call and/or a letter is sent indicating what is still needed to process the application. If no response is received, the application will be reviewed by the Financial Assistance/Community Care Program committee to determine if collection proceedings should resume or if presumptive charity care be allowed. Patients will be notified when the facility determines the amount of financial assistance approved. Part VI, Line 2: The Organization typically offers wellness screenings once a year at no cost to the public, however they were unable to perform them this year due to provider illnesses and Covid outbreak status in the community. The wellness screenings help the Organization to assess health needs of the community. Included are blood pressure checks, diabetes screenings, pulmonary and respiratory screenings, and education on good health. This often results in follow-up care after results of screenings are reviewed. The organization also offers a community weight loss program (GORED) as well as wellness luncheons on related health topics. A community health needs assessment was also conducted during the 6/30/22 fiscal year end to help assess needs in the community. Part VI, Line 3: Patients receive charity care information through the business office. The Organization mails brochures regarding the program in past due statements. The Organization also gives the brochure to people in the community known to the Organization that do not have insurance upon arrival for a visit. The charity care information is part of the intake process. Part VI, Line 4: As of the census of 2010, there were 2,420 people and 1,086 households residing in the county. The population density was 3.4 people per square mile. There were 1,451 housing units. The racial makeup of the county was 98.90% White, 0.20% Asian, 0.30% Black, 0.50% American Indian and Alaska Native persons, and 0.10% from other races. There were 1,086 households out of which 23.80% had children under the age of 18 living with them, 55.00% were married couples living together, 5.30% had a female householder with no husband present, and 36.90% were non-families. Of the non-family households, 33.70% of householders lived alone and 18.20% of householders living alone, were 65 years of age or older. The average household size was 2.16 and the average family size was 2.74.In the county the population was spread out with 20.40% under the age of 19, 2.5% from 20 to 24, 17.30% from 25 to 44, 33.40% from 45 to 64, and 26.40% who were 65 years of age or older. The median age was 51.9 years. The median income for a household in the county was $43,000, and the median income for a family was $55,724. About 5.10% of families and 9.70% of the population were below the poverty line, including 9.80% of those under age 18 and 20.2% of those ages 65 or over. Part VI, Line 5: The Organization offers a variety of services to the community to assist in taking away the burden of having to travel for medical care. The Organization also assists in accommodating any financial concerns through the charity care program. By doing both, the Organization hopes to better the well-being of the community. The Board of Directors is comprised of persons who reside in the primary service area. Medical staff privileges are given to all qualified physicians in the community. The Organization is affiliated with Emergency Heart Network, St. Paul Ramsey Burn Center, and Life Flight. When available, surplus funds are used to upgrade patient care equipment and facility infrastructure.The organization continued to offer COVID-19 screenings available at no cost to the public, unless a physician visit was required due to the patient's condition. 0 0 0 0 0 0 0 0 0 Steven Barlow Mid-Level/Nurse Practioner 288034 0 2087 0 0 0 5203 0 32931 0 328255 0 0 0 Debra Middleton Mid-Level/Nurse Practition 244473 0 2071 0 0 0 5478 0 11457 0 263479 0 0 0 Larissa Haug PA 178224 0 2117 0 0 0 4554 0 37498 0 222393 0 0 0 Nicole Lindsey CEO - Administrator 48219 0 673 0 0 0 1968 0 6511 0 57371 0 0 0 Part I, Line 3 Nicole Lindsey, CEO, is an employee of Griggs County Care Center (GCCC), an unrelated organization. Nicole's compensation is determined by an agreement of both the board of directors of GCCC and the Organization. She is paid by GCCC and 30 percent of her compensation is billed by GCCC to the Organization. The amounts reported in Part VII and on schedule J represent 30 percent of her compensation. Darnell Lindsey Husband of CEO, Nicole Lindsey 28000 Compensation 0 Form 990 - Amended Return: The orginally filed Form 990 has been amended to reflect the final audited financial statements for the year ending June 30, 2022. The originally filed Form 990 was prepared using draft financial statements. The following parts of the Form 990 were changed on this amended Form 990 from the originally filed Form 990: -Final financial statements are now attached -Part I: Current year numbers changed to reflect changes in other parts of the return -Part II: updated signer -Part III, line 4a, Program expenses -Part IV, line 11f and 12b to indicate audited financial statements were obtained -Part VI, line 20 updated books in care of -Part IX, line 11g, line 16 allocation, line 19 -Part X, line 4, 16, 17,26 27, 32, 33 -Part XII, line 2b and 2c -Schedule D, part XI, XII and XIII -Schedule H, part I, line 7g, 7i, 7k -Schedule H, part III, line 4 Form 990, Part VI, Section A, line 1a An Executive Committee may be appointed or dissolved by a majority vote of the Board of Directors. If so formed, the Executive Committee, in addition to the Chairman of the board and the Administrator, shall consist of the Secretary, the Treasurer, and one (1) additional member of the Board of Directors elected by the board at its first meeting after its election. The Executive Committee shall have power to transact all regular business of the Cooperstown Medical Center during the period between the meetings of the Board of Directors, subject to any prior limitations imposed by the Board and with the understanding that all matters of major importance will be referred to the Board of Directors. Minutes of the Executive Committee meetings shall be submitted to the Board, and its actions shall be subject to approval or disapproval at the next regular Board meeting. Form 990, Part VI, Section A, line 2 Nicole Lindsey and Barbara Anderson have a business relationship. Barbara Anderson and James Halvorson have a family relationship. Form 990, Part VI, Section A, line 6 The Organization has members consisting of those persons who are 18 years of age or above residing in the area served by Cooperstown Medical Center. Form 990, Part VI, Section A, line 7a The Members elect the Board of Directors. Form 990, Part VI, Section B, line 11b The CFO reviews the Form 990 prior to filing with the Internal Revenue Service. The Board of Directors also receives a copy of the Form 990 by email prior to it being filed with the IRS. Form 990, Part VI, Section B, line 12c Each board member annually and upon hire each corporate officer, executive, department director, supervisor or other individual, duly authorized by the governing body to conduct business on behalf of Cooperstown Medical Center signs a statement which affirms that such person: 1) has received a copy of the conflict of interest policy; 2) has read and understands the policy; 3) has agreed to comply with the policy; 4) understands that the organization is and includes charitable organizations and that in order to maintain its federal tax exemption it must engage primarily in activities which further one or more of its tax-exempt purposes. If a conflict arises, the board will assign a disinterested person to investigate alternatives to the proposed transaction or arrangement. The interested member is to provide information to the board, however not influence the board regarding their decision. Form 990, Part VI, Section B, line 15 Nicole Lindsey, CEO, is an employee of Griggs County Care Center (GCCC), an unrelated organization. Nicole's compensation is determined by an agreement of both the board of directors of GCCC and the Organization. She is paid by GCCC and 30 percent of her compensation is billed by GCCC to the Organization. The CFO, Barbara Anderson, was compensated for her services to the Organization as well as for her services to Griggs County Care Center (GCCC) an unrelated organization. Her compensation was determined by an agreement between both the Organization's board of directors and that of GCCC. Thirty percent of her compensation is billed to and reimbursed by GCCC. The amounts reported in part VII represent all of her compensation including the thirty percent that is billed to GCCC. 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 and at the annual meeting. Form 990, Part IX, line 11g Professional Fees: Program service expenses 340,216. Management and general expenses 54,170. Fundraising expenses 0. Total expenses 394,386. Purchased Services: Program service expenses 418,966. Management and general expenses 163,289. Fundraising expenses 0. Total expenses 582,255. Consultant Fees: Program service expenses 20,257. Management and general expenses 0. Fundraising expenses 0. Total expenses 20,257. Cooperstown Medical Center Foundation 1200 Roberts Ave NE Cooperstown ND 58425 450450301 To support the programs of the Cooperstown Medical Center ND 501(c)(3) Line 7 Cooperstown Medical Center 1 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 0 0