2025-03-20T16:45:59-05:00 2024-06-30 450250958 Eide Bailly LLP 4585 Coleman St Ste 200 Bismarck ND 58503 990 2023-07-01 450255914 Ashley Medical Center ASHL 7012883433 PO Box 450 612 Center Ave N Ashley ND 584130450 Eric Heupel CEO 7012883433 2025-03-19 1 1 Lisa Chaffee CPA P00193453 7012551091 2025-03-19 2023 2025-03-06 01:10:19Z Corey Ulmer PO Box 450 612 Center Ave N Ashley ND 584130450 14025395 0 X amctoday.org X 1952 ND To construct, maintain, and operate health care facilities in the community of Ashley, ND. 9 9 140 15 0 0 734740 2557756 9888770 10844485 -20186 -20186 5880 4830 10609204 13386885 0 0 0 0 5888992 6839315 0 0 0 4578783 4579870 10467775 11419185 141429 1967700 6453791 8731512 1051425 1300767 5402366 7430745 X Ashley Medical Center is a community organization which provides preventative, curative, supportive and educational health care that meets the physical, emotional, and spiritual needs of the people we serve. 0 0 6122877 5581388 Acute health care consisting of Inpatient days of 104, Outpatient hours of 2,032 and swing bed days of 1,204. 2132892 4251867 Long term skilled care for the frail and elderly total resident days of 10,722. 1384035 803449 Rural Health Clinic Services with 3,002 clinic visits. 107005 207781 Other program services include apartment space to the elderly and low income under business code 721310 107005 207781 9746809 1 1 0 0 0 0 0 0 1 0 1 0 0 0 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 31 0 1 140 1 0 0 0 0 0 0 0 0 0 0 0 0 X 9 9 0 0 0 0 1 1 0 1 1 0 0 1 1 1 1 1 1 1 1 0 X Corey Ulmer 7012885258 612 Center Ave N Ashley ND 584130450 Polly Wyrick Ulrich President (Jul-Oct) 1.00 X X 0 0 0 Brenda Meyer President 1.00 X X 0 0 0 Anthony Neu Vice President 1.00 X X 0 0 0 Kristie Morrison Secretary 1.00 X X 0 0 0 JoAnne Stugelmayer Board Member 0.50 X 0 0 0 Megan Thomas Board Member 0.50 X 0 0 0 Abigail Ward Board Member 0.50 X 0 0 0 Adam Wishek Board Member 0.50 X 0 0 0 Candace Nies Board Member 0.50 X 0 0 0 Angela Bertsch Board Member 0.50 X 0 0 0 Corey Ulmer CFO 40.00 X 83153 0 30901 Eric Heupel CEO 40.00 X 154841 0 47739 Lori Bichler Nurse Practitioner 40.00 X 274443 0 38967 Jeremy St Aubin Physical Therapist 40.00 X 124992 0 27356 Michael Vanhorn Radiology Technician 40.00 X 102014 0 17679 Cori Randall Nurse Practitioner 40.00 X 179485 0 48847 Jodi Haas Registered Nurse 40.00 X 122091 0 16620 1041019 0 228109 6 0 1 0 DTN Staffing 1200 Collins Ave Mandan ND 58554 Contracted Nursing Services 363622 Homestead Recruiters Inc 821 Senior Ave Dickinson ND 58601 Contracted Nursing Services 358843 West Dakota Medical Services 10710 Rose Dr Bismarck ND 58503 Locum Provider Services 139224 4D Kares 13210 363 Ave Ipswich SD 57451 Contracted Nursing Services 127360 Sarina Victoria 7770 Hwy 18 Wyndmere ND 58081 Contracted Nursing Services 119527 6 2504239 53517 2151 2557756 Net Patient Revenue 623000 10728521 10728521 115964 115964 10844485 4830 0 4830 4830 4830 618324 638510 -20186 -20186 -20186 13386885 10844485 0 -15356 X 371940 371940 5071338 4760712 310626 138001 130307 7694 881456 829057 52399 376580 333306 43274 1479 1479 76945 76945 1996439 1478977 517462 45622 23753 21869 218820 172338 46482 218514 212502 6012 51862 47636 4226 15097 12963 2134 8092 7541 551 336374 313510 22864 110452 9553 100899 Medical Supplies 1081828 1081231 597 Maintenance and Repairs 240710 228996 11714 Equipment Rentals 69447 69447 Rentals 5392 5392 102797 34980 67817 11419185 9746809 1672376 0 224 224 2538432 2222758 1478192 3719849 158893 192809 93221 104070 9803121 8022770 1846932 1780351 137897 498486 200000 212965 6453791 8731512 733839 1045343 11599 12591 274709 222661 31278 20172 1051425 1300767 X 5347211 7375590 55155 55155 5402366 7430745 6453791 8731512 1967700 60679 0 X 0 1 X 0 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 1 X 25001 25001 85987 6172141 5082636 1175492 3519992 2940134 579858 1780351 Capital Lease 20172 20172 X 13447564 60679 60679 13386885 0 13386885 11419185 0 11419185 0 11419185 Part IV, Line 2b: The Medical Center acts as custodian for the funds of the residents and holds security deposits for the apartments. These funds are included in cash and cash equivalents and accounts payable in the accompanying balance sheets. Part X, Line 2: The Medical Center believes it has appropriate support for any tax positions taken affecting the annual filing requirements for the Medical Center, 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 liabilities in income tax expense if such interest and penalties are incurred. 1 1 X 1 X 1 X 1 1 0 0 6000 6000 0.00050 2844346 2709030 135316 0.01180 2850346 2709030 141316 0.01230 79027 4690 74337 0.00650 90600 50490 40110 0.00350 169627 55180 114447 0.01000 3019973 2764210 255763 0.02230 1 0 0 3543730 3861749 -318019 X 1 1 1 1 Ashley Medical Center PO Box 450 612 Center Avenue North Ashley ND 584130450 amctoday.org 5001 X X X Swingbed Ashley Medical Center 1 0 0 1 X X X X X X X X X 21 1 0 1 1 X http://amctoday.org/services X X 1 21 1 http://amctoday.org/services 0 1 X 100.000000000000 200.000000000000 X X 1 1 X X X X 1 X http://amctoday.org/services X http://amctoday.org/services X http://amctoday.org/services X X X X X 1 X 0 X X X X 1 X 0 0 Ashley 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, from November 22nd to December 16th, 2021. Thirty-nine AMC service area residents completed the survey. Additional information was collected through six key informant interviews with community members conducted November 22, 2021. The input from the residents, who primarily reside in McIntosh 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 Ashley Medical Center Part V, Section B, Line 6b: McIntosh County Public Health assisted with the assessment. Ashley Medical Center Part V, Section B, Line 7d: Copies were left at our municipal offices downtown. Ashley Medical Center Part V, Section B, Line 11: The top four priorities identified in our 6/30/2022 CHNA were:*Assisted living options*Ability to recruit and retain a primary care provider*Depression/ Anxiety in youth and adults*Having enough child daycare services.The hospital will not address the last two needs identified. Depression/ Anxiety in youth and adults is a matter the Ashley Medical Center feels we don't have a lot of control over. We will try to combat this by promoting to live a healthy lifestyle and by bringing awareness to this issue.The CHNA took place prior to a new daycare opening. This eliminated the preexisting need of adequate childcare.The assisted living option is on the Ashley Medical Centers radar. This is something that is in our future plans. We have eight independent living apartments that we are in the process of converting into assisted living apartments. We are currently renovating each apartment as they become vacant. We hope to be able to meet this need in the near future.The Ashley Medical Center is trying to solve the issue of recruiting and retaining a primary care provider by continuing to recruit and retain primary care providers. We offer competitive wages with the surrounding communities. This is something we will continue to monitor. We also have many active volunteers participating in community organizations that are aimed at supporting and building a better community. We will continue to support the volunteers that are a part of this organization, as well as the organizations themselves. 3 1 - Ashley Medical Center SNF 612 Center Ave N Ashley ND 584130450 Long Term Care Facility 2 - AMC Clinic Ashley 612 Center Ave N Ashley ND 584130450 Rural Health Clinic 3 - AMC Clinic Zeeland 203 South Main Zeeland ND 58581 Rural Health Clinic Part I, Line 3c: The Hospital also considers medical indigency and asset level to determine eligibility for financial aid. 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. Community health improvement services, line 7e, is actual costs reported in the general ledger. The cost for medicaid on line 7b and subsidized health services reported on line 7g were determined using the cost report. Part III, Line 2: In fiscal year 2024, the Hospital had a bad debt recovery greater than the current year bad debt expense and implicit price concessions. Part III, Line 3: The organization reasonably estimates the portion of implicit price concessions that could have qualified for charity care based on historical data. An estimated 10% of implicit price concessions in 2023 are attributable to patients potentially eligible for charity care. In fiscal year 2024, the Hospital had a bad debt recovery greater than the current year bad debt expense. Therefore there was no overall community benefit from bad debt expense or implicit price concessions in the current fiscal year. Part III, Line 4: The financial statement footnote regarding implicit price concessions may be found on page 10-11 of the audited financial statements. Part III, Line 8: Medicare allowable costs of care are based on the Medicare cost report. The Medicare cost report is completed based on the rules and regulations set forth by Centers for Medicare & Medicaid Services. The costs themselves are a community benefit as the community would not receive these services if we did not provide them. Part III, Line 9b: It is the policy of the Ashley Medical Center to forego extraordinary collection efforts against an individual before the organization has made a reasonable effort to determine whether the individual is eligible for assistance under the hospital charity care policy. Those who qualify for financial assistance will not be charged more than the amount generally billed to other patrons for Emergency Services (described in the EMTALA) or Medically Necessary services. The hospital billings and collections policy provides written notice at least 30 days prior to initiating collection actions. The hospital does not send patient accounts to collections until at least 120 days after the date of the first invoice. If a patient applies for financial assistance within 240 days of the date of the first invoice the hospital will pull that account or invoice back from collections. Part VI, Line 2: The Ashley Medical Center conducts an annual program review to evaluate current programs as well as determine any future programs that may be needed within our healthcare community. Part VI, Line 3: Ashley Medical Center provides insurance counseling throughout the year to our patients and provides contact information for state and federal programs. We provide patients of need with a copy of our financial assistance program and post it at various locations throughout the facility including the ER, admissions, and AMC Clinic. Our financial assistance program and its summary is posted to our website. Part VI, Line 4: Ashley Medical Center (AMC) provides health care services to a rural and frontier geography that includes the cities of Ashley, Lehr, Zeeland and Wishek in McIntosh County. In Logan County we serve the cities of Gackle, Fredonia, and Napoleon. Dickey County cities include Ellendale and Forbes. In Emmons County we have patients from Hague and Strasburg. We also have patients from Kulm located in LaMoure County. All the preceding counties are located in North Dakota. In South Dakota we serve patients from Long Lake and the Leola area located in McPherson County as well as Eureka in Campbell County. In total we serve around 3500 people. There are approximately 3.5 persons per square mile, compared to about 80 per square mile across the United States. AMC strives to provide access to the best quality of care, regardless of the geographic barrier.Socio-Economic Status: McIntosh County has a high number of Medicare recipients, with 30.7% over 65 in 2018. The median income for a household is $50,739. The per capita income for the county is $32,389, 13.6% of the population is below the poverty level. Because of the low income levels, it is imperative that the patients be able to have access to the highest levels of medical care, without having to travel great distances and incur great costs.Race and Ethnicity: The racial makeup of McIntosh Co is 96.3% White, 0.05% Black or African American, 0.7% Native American, 0.29% Asian, 1.5% Pacific Islander, 0.00% from other races and 0.9% from two or more races. 2.4% of the population is Hispanic or Latino.The Ashley Medical Center serves as a "hub" for community-based health services, integrating different levels of care and services through one organizational structure. We are essential to our patients not only for acute care and emergency care services but also are the link for primary care, nursing home services, elder care services and living structures. AMC extends beyond the standard definition of a hospital.AMC serves an ever growing vulnerable population. This is due to the high number of elderly in our service area. The Medicare factor exacerbates access issues related to geographical considerations, income disparity, lower insurance coverage, and greater health disparities. Part VI, Line 5: The Ashley Medical Center (AMC) is a non-profit, community owned hospital located in Ashley, North Dakota. AMC is governed by a publicly elected nine-member board of directors. These members are residents of our community. It is the largest hospital complex in McIntosh County and serves an approximate 50-mile radius around Ashley. AMC extends medical staff privilieges to all qualified physicians in its community.It is the policy of the Ashley Medical Center to provide as direct services medical emergency procedures as a first response to common life-threatening injuries and acute illness. Services are available to all residents, patients, and visitors regardless of age, race, national origin, disability, or ability to pay.In Fiscal Year 2024 the Ashley Medical Center continued it's cooperation with Bismarck State College in bringing the Dakota Nursing Program to the community of Ashley. We are currently doing a hybrid RN course that has the students splitting classroom time between the Ashley Medical Center and Bismarck State College. We have 2 students pursuing an RN Degree.We provide an annual heart check wellness. This screening is available anytime during the calendar quarter of the patient's birthday. We offer this screening at a reduced rate of $50 as opposed to the standard price of $205 to have the lab tests provided. X X 0 0 0 0 0 0 0 0 0 Lori Bichler Nurse Practitioner 274443 0 0 0 0 0 8383 0 30832 0 313658 0 0 0 Cori Randall Nurse Practitioner 179485 0 0 0 0 0 5543 0 43551 0 228579 0 0 0 Eric Heupel CEO 154841 0 0 0 0 0 4793 0 43194 0 202828 0 0 0 Jeremy St Aubin Physical Therapist 124992 0 0 0 0 0 3905 0 23698 0 152595 0 0 0 Form 990, Part VI, Section A, line 1a The Executive Committee shall consist of the President, the Vice President, the Secretary and two additional members of the Board of Directors, elected by the Board of Directors at its organization meeting following the annual meeting of the members. The Executive Committee shall have the power to transact all regular business of the corporation during the period between the meetings of the Board of Directors, subject to any prior limitation imposed by the Board of Directors and with the understanding that all matters of major importance will be referred to the Board of Directors. The Executive Committee currently operates with the President, Vice President, Secretary and one additional board member. Form 990, Part VI, Section A, line 6 Membership or stockholders are given voting rights by making a $100 contribution to the Ashley Medical Center. Form 990, Part VI, Section A, line 7a All members that have made a $100 donation to the Ashley Medical Center are able to elect our Board of Directors. Form 990, Part VI, Section B, line 11b All board members received a copy of the 990 in the monthly board packet, which is reviewed at the board meeting prior to being filed with the IRS. Form 990, Part VI, Section B, line 12c The conflict of interest policy covers the board of directors and officers. The directors and officers are required to annually disclose any potential conflicts. The board of directors reviews for conflicts. If a conflict is identified the person must abstain from voting and remove themselves from discussions. Form 990, Part VI, Section B, line 15 The compensation for Eric Heupel was approved by the independent board using comparative data. The deliberation process for reasonable compensation was substantiated in the minutes. The CFO salary is annually determined by the board and compared to the state hospital association salary survey. 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. Management is responsible for honoring these requests. Form 990, Part IX, line 11g Professional Fees: Program service expenses 1,478,977. Management and general expenses 517,462. Fundraising expenses 0. Total expenses 1,996,439.