2024-04-25T09:11:04-05:00 2023-06-30 450250958 Eide Bailly LLP 1730 Burnt Boat Loop Ste 100 Bismarck ND 585030886 990 2022-07-01 450308484 Tioga Medical Center TIOG 7016643305 PO Box 159 Tioga ND 58852 Jamie Eraas President & CEO 7016643305 2024-04-17 1 Jamie Eraas 999009999 1 Lisa Chaffee CPA P00193453 7012551091 2024-04-17 2 AAL1 IAL1 2022 2023-04-26 12:10:37Z Jamie Eraas PO Box 159 Tioga ND 58852 20601348 0 X www.tiogahealth.org X 1960 ND Health care and nursing care services 9 6 170 150 0 0 2092375 3991674 15463158 16239621 24019 21166 94880 321314 17674432 20573775 0 4500 0 0 8551510 9052805 0 0 0 7365373 7906613 15916883 16963918 1757549 3609857 22606994 25723240 7723060 7192435 14883934 18530805 X The mission of Tioga Medical Center is to address the health care needs of the community through providing quality health care and promoting education and wellness. 0 0 7695052 4500 10145520 Tioga Medical Center provides delivery of healthcare services over eastern Williams county, Burke County and western Mountrail county of the state of North Dakota.Requirements of the IRS community benefit standard for tax-exempt organizations are integral to Tioga Medical Center's larger charitable mission of improving health and quality of life. Specifically, an independent board including community leaders, business experts and consumer representatives governs Tioga Medical Center. The Board has a history of commitment to acting with the highest integrity. For example:-Policies on confidentiality of patient and corporate information are reviewed annually as a component of mandatory education, and a confidentiality statement is signed and/or reviewed annually by all employees and board members.-Board members and key employees review and sign a conflict of interest statement annually.-Tioga Medical Center's code of conduct is published in its employee handbook and included in general orientation of all new employees and volunteers.Tioga Medical Center also makes medical care accessible to the entire community it serves. Tioga Medical Center operates a 24 hour emergency room and provides emergency care regardless of ability to pay. Tioga Medical Center had 1,944 emergency room visits during the past fiscal year. Tioga Medical Center provides clinical services needed to operate the emergency room.In addition, Tioga Medical Center provides non-emergency services to the community it serves. It makes these services accessible to the community through participation in government programs like Medicare and Medicaid and by offering assistance through the Tioga Medical Center's uncompensated care program.Tioga Medical Center's uncompensated care (charity care) program provides free services to patients who lack the resources to be fully responsible for the health care they receive. The uncompensated care program is designed to ensure the entire community served by Tioga Medical Center has access to needed healthcare services. The Tioga Medical Center administration oversees services delivered under the uncompensated care program, including assessing community needs, approving eligibility criteria and monitoring the effectiveness of the program in providing community access to medical care.Tioga Medical Center maintains records to identify and monitor the level of care provided under the uncompensated care program. These records include the amount of charges foregone for services and supplies furnished under its charity care program. Tioga Medical Center had costs for charity care for the year ended June 30, 2023 of approximately $29,000.Tioga Medical Center takes its mission to improve the health and quality of life of the people it serves a step further by reaching out to meet the broad needs of the community. It strives to identify the community needs beyond basic healthcare, and then respond to them, aiming to make a positive, life-enhancing difference in the community. For example, many employees and Board members of Tioga Medical Center are actively involved in volunteer organizations that serve to protect the community, such as the Tioga Fire & Ambulance Department. As a small community, it is vital for people to come to the aid, as volunteers, when people are in need of assistance. Tioga Medical Center allows its employees to leave the workplace to tend to the emergency needs of the community we serve.The Tioga Medical Center, located at Tioga, North Dakota, is a provider of integrated healthcare delivery services consisting of a 25 bed Medicare designated Critical Access Hospital (CAH). The Tioga Medical Center CAH is a Level V designated trauma center. Within the CAH, acute care services are provided, along with swing bed services. 3167766 3727846 Attached to the CAH is a 30 bed skilled nursing facility. This facility provides skilled and long term care services to its residents. 2599310 2128972 The Medical Center also operates three clinics located in Tioga, Ray, and Powers Lake. These clinics are Medicare and Medicaid designated provider-based rural health clinics. Within the clinics, they employ one Family Medicine Physician, two Physician Assistants and two Family Nurse Practitioners. These practitioners provide physician related services at these clinics, as well as to the CAH and SNF. 250401 237283 Finally, attached to the Nursing home is a 22 unit independent living unit. The organization also has a Foundation that distributes scholarships. 250401 237283 13712529 1 1 0 1 0 0 0 0 1 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 1 0 0 0 0 0 0 0 0 0 0 1 12 0 1 170 1 0 0 0 0 0 0 0 0 0 0 0 0 X 9 6 1 0 0 0 1 1 0 1 0 0 0 1 1 1 1 1 1 1 1 0 X Jamie Eraas 7016643368 PO Box 159 Tioga ND 58852 James Booth Chairman 1.00 X X 0 0 0 Brodie Odegaard Vice Chairman 0.50 X X 0 0 0 Wendy Lenzen Secretary/Treasurer 0.50 X X 0 0 0 Nathan Germundson Director 0.50 X 0 0 0 Lee Olson Director 0.50 X 0 0 0 Seth Wisthoff Director 0.50 X 0 0 0 Jeremy Becker Director 0.50 X 0 0 0 Carolyn Eide Director thru March 2023 0.50 X 0 0 0 Brandon Hauge Director thru January 2023 0.50 X 0 0 0 Kristopher Kuehn Director as of March 2023 0.50 X 0 0 0 Patrick Joyce Director as of March 2023 0.50 X 0 0 0 Holly Bryant CFO as of February 2023 40.00 X 0 0 0 Ryan Mickelsen CEO/Pres. thru January 2023 40.00 X 189369 0 39008 Jamie Eraas - CFO thru Jan 2023/CEO as of Feb 2023 40.00 X 87353 0 3153 Dr Robert Rotering Medical Director/Physician 40.00 X 426056 0 18972 Jeffrey Moberg Jr Physician Assistant 40.00 X 352844 0 42190 Jesse Mitchell Nurse Practitioner 40.00 X 209295 0 27865 Shelby Knox Physician Assistant 40.00 X 224668 0 19322 Nancy Carlson Nurse Practitioner 40.00 X 148818 0 27390 1638403 0 177900 10 0 1 0 Homestead Recruiters 821 Senior Ave Dickinson ND 58601 Contract Nursing 1447650 OneStaff Medical PO Box 3544 Omaha NE 681030544 Contract Nursing 121023 2 3945019 46655 3991674 Patient & Resident Revenue 621110 15574608 15574608 340B Pharmacy 456110 495945 495945 Other Revenue 900099 169068 169068 16239621 27242 27242 327263 327263 9468 15417 -5949 -5949 -5949 6080 12156 0 -12156 6080 -6076 -6076 20573775 16239621 0 342480 X 4500 4500 323006 323006 302309 302309 6911103 5620881 1290222 262232 211763 50469 756175 600974 155201 497980 392101 105879 7153 7153 423841 423841 5910 5910 2491556 2491556 40369 40369 500018 388698 111320 465039 465039 406800 403779 3021 44247 16870 27377 28026 14436 13590 122486 122486 1164775 1114326 50449 94709 94709 Medical Supplies 1347257 1347257 Repairs and Maintenance 309492 268719 40773 Food 236580 236580 Dues and Subscriptions 26566 26566 191789 80585 111204 16963918 13712529 3251389 0 5653523 4592196 10695 2866507 2910059 107275 94179 105837 133955 26667458 15684242 11814927 10983216 1853054 3167735 205871 3831205 22606994 25723240 1187645 934659 333831 11075 10125 6190509 5889561 0 358090 7723060 7192435 X 14877434 18524305 6500 6500 14883934 18530805 22606994 25723240 3609857 37014 0 X 0 1 X 1 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 1 2970 0 0 0 2970 0 Part II-B, Line 1: Tioga Medical Center is a member of the American Hospital Association (AHA), the North Dakota Hospital Association (NDHA), and the North Dakota Long Term Care Association (NDLTCA). A portion of the membership dues for these organizations are used for lobbying. 0 1 X 14053 14053 739067 17549667 9000019 9288715 7671351 6145814 1525537 693320 538409 154911 10983216 Estimated third-party payor settlements 195000 Sales Tax Receivable 55622 ERC Receivable 3222493 Operating Lease ROU Assets 358090 3831205 Opearting Lease Liability 358090 358090 X 20620296 37014 37014 20583282 5910 -15417 -9507 20573775 16973425 15417 15417 16958008 5910 5910 16963918 Part IV, Line 2b: The Organization holds funds under an agency relationship for the residents of the nursing facility. Part X, Line 2: The Medical Center 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. 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 -15,417. Part XII, Line 2d - Other Adjustments: Rental Expenses 15,417. 1 1 X 1 X 110.000000000000 1 X 0 0 0 29000 29000 0.00170 2500345 2312079 188266 0.01110 2529345 2312079 217266 0.01280 17653 17653 0.00100 153525 153525 0.00910 2353503 2048644 304859 0.01800 2524681 2048644 476037 0.02810 5054026 4360723 693303 0.04090 1 480000 38400 4483914 4511368 -27454 X 1 1 1 1 Tioga Medical Center Hospital 810 Welo Street Tioga ND 58852 www.tiogahealth.org 5048P X X X X 3 provider based rural health clinics Tioga Medical Center Hospital 1 0 0 1 X X X X X X X X X 21 1 0 1 1 X https://www.tiogahealth.org/him X 1 21 1 https://www.tiogahealth.org/him 0 1 X 110.000000000000 200.000000000000 1 1 X X X X 1 X https://www.tiogahealth.org/him X https://www.tiogahealth.org/him X https://www.tiogahealth.org/him X X X X X X 1 X 0 X X X X 1 X 0 0 Tioga Medical Center Hospital Part V, Section B, Line 5: Tioga Medical Center distributed health needs surveys to patients at the hospital and clinic. Surveys were distributed at the senior citizens center. Public meetings were advertised in the local paper inviting all community members to participate. Special invitations were sent to members of the Community Ambulance Service and local business owner, the Chief of Police, The Elementary School Principal, Powers Lake Ambulance Service Squad Leaders, Ray Ambulance Squad Leaders, License Counselor, and representative of Faith. Tioga Medical Center Hospital Part V, Section B, Line 6b: Tioga Medical Center's CHNA was conducted in collaboration with the Upper Missouri Public Health District. Tioga Medical Center Hospital Part V, Section B, Line 11: In the most recent CHNA conducted the following needs were identified:1. Attracting and retaining young families2. Depression/anxiety - all ages3. Having enough child daycare servicesThe organization will address all of the identified needs.In the current year the facility has taken the following actions to address the identified needs: Attracting and retaining young families & Having enough child daycare services: Tioga Medical Center has been actively participating in activities and events put on by the City of Tioga, Tioga School District, Tioga Rec Council, Tioga Park Board, Tioga Farm Festival Committee, Tioga Freedom Fest Committee, and more organizations. We have worked in conjunction with these organizations to help coordinate and promote events that are enticing to young families and help attract and retain these families in our community. We are active in these organizations in planning and participating in events and also help on the promotional side, as we have resources such as an electronic sign that is located on a high traffic road in Tioga and a very active Facebook Group that we can help promote awareness of events on. We also are becoming more active in our Tioga Area Economic Development Corporation and Tioga Chamber of Commerce. Through these groups we are working collaboratively to address the issues of attracting and retaining young families and having enough child daycare services. Having a viable and thriving medical facility is an important quality for our community when attracting employees for our businesses, school teachers, and other key personnel that are needed in our town. Depression/anxiety among the youth: Tioga Medical Center has made addressing Depression and anxiety among the youth a priority. The Tioga Medical Center providers and nursing staff complete educational courses with the youth and adolescents at Tioga Public School and Ray Public School on an annual basis. The education sessions are based on puberty and hormone changes and the effects that these changes have on the mood of youth and adolescence. Tioga Medical Center has also continued to work closely with Melissa Nystuen, LCSW, to strengthen her services that she provides in the specialty clinic at Tioga Medical Center on an increasing basis. We have also worked to be an aide in Melissa being a part of the Tioga School District System. Wellness and Mental Health Awareness have been two subjects that Tioga Medical Center has made a priority in providing services for since the COVID-19 Pandemic began. We continue to promote mental health awareness and wellness through social media and public education. Our partnership with ConnectUS Therapy has continued since 2021. ConnectUS Therapy provides mental health medication management in Tioga and continues to see growth in the number of patients they see at Tioga Medical Center in the specialty clinic. Tioga Medical Center Hospital Part V, Section B, Line 16j: If a patient does not have financial resources, the hospital asks if they have applied for medical assistance. Financial assistance is discussed with ER patients upon discharge and discussed upon admissions for all other services. Follow-up letters are sent separate from the bills on accounts that have not had payments for 90 days to remind patients that there is a charity care program available to them.A charity care application is sent with patient statements after 60 days. 1 1 - Tioga Medical Center Long Term Care 810 Welo Street Tioga ND 58852 Skilled Nursing Facility 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, and Health professionals education, line 7f, reflects actual expenses recorded to the general ledger. Medicaid, line 7b, and subsidized health services, line 7g, were calculated based on information from the Cost Report. 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: The estimated amount of the organization's implicit price concessions attributable to patients eligible under the organization's charity care policy was calculated by applying the estimated percentage of the service area below the poverty guideline (8.0%) to the amount of implicit price concessions. Part III, Line 4: The footnote to the Organization's financial statements can be found on pages 12 and 13 of the attached audited financial statements. Part III, Line 8: Medicare allowable cost is based on 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.All of the Medicare shortfall should be treated as a community benefit. The Organization treats individuals regardless of the ability to pay. Most of the Medicare shortfall comes from the nursing home. The elderly are an underserved population who experience issues with access to healthcare services. It is a community benefit to be able to treat them at the local nursing home. Part III, Line 9b: The billing and collection policy applies to all patients. Every effort is made to determine if a patient may be eligible for charity care. No collection actions are taken if a patient is in the process of applying for charity care or has been accepted for charity care. Any personal portion due would follow normal collection procedures. Part VI, Line 2: In addition to a Community Health Needs Assessment, a formal needs assessment has been conducted where providers are able to bring identified needs to administration. The identified needs are reviewed by the physicians/providers as well. The request is analyzed to see if it can be cost-justified; then, the request is brought to the Board of Directors for approval. Dexa Scan, Diabetes Education, an OR remodel, eEmergency, the purchase of an ablasion machine, and the purchase of a diagnostic ultrasound have all been added in the past five years through this process. Part VI, Line 3: If a patient does not have financial resources, the hospital asks if they have applied for medical assistance. Financial assistance is discussed with ER patients upon discharge and discussed upon admissions for all other services. Follow-up letters are sent separate from the bills on accounts that have not had payments for 90 days to remind patients that there is a charity care program available to them. Monthly Statements include a notice regarding uncompensated care. Uncompensated Care letters are also included with past due (60 day) account statements. Part VI, Line 4: The hospital's primary service area consists of residents in Williams County, with some residents of Mountrail/Burke Counties. The primary industries in this area are agriculture, oil, and tourism. Williams County had an estimated population of 40,950 as of 2020 according to census.gov. An estimated 10.6% of the population was 65 or older in 2022, and 8.0% were estimated below the poverty level in 2022. Part VI, Line 5: Tioga Medical Center furthers its exempt purpose by promoting the health of the community through:* Medical staff privileges are extended to all community providers* Surplus funds are reinvested into equipment and facility upgrade* The next closest hospital is 30 miles away from the organization - sole provider in the immediate area* Provide emergency care regardless of a patient's ability to pay* Employees serve on a voluntary ambulance and fire department and the organization allows the employees to serve those duties without punching out* Therapy departments talk to coaches about sports injuries and educate coaches on caring for injuries* Educate senior citizen groups on medical awareness topics* Diabetes education services are provided to patients of Tioga Medical Center at no cost to the patient.*Collaboration with Williston State College to educate nurses*Collaboration with The University of North Dakota to educate providers in rural medicine*Collaboration with The University of North Dakota and The University of Mary to educate occupational and physical therapists. X X 1 1 X X X 0 0 0 0 0 0 0 0 0 Dr Robert Rotering Medical Director/Physician 413976 0 12080 0 0 0 9093 0 9879 0 445028 0 0 0 Jeffrey Moberg Jr Physician Assistant 350764 0 2080 0 0 0 9025 0 33165 0 395034 0 0 0 Shelby Knox Physician Assistant 222588 0 2080 0 0 0 6806 0 12516 0 243990 0 0 0 Jesse Mitchell Nurse Practitioner 207215 0 2080 0 0 0 0 0 27865 0 237160 0 0 0 Ryan Mickelsen CEO/Pres. thru January 2023 187289 0 2080 0 0 0 6045 0 32963 0 228377 0 0 0 Nancy Carlson Nurse Practitioner 147154 0 1664 0 0 0 0 0 27390 0 176208 0 0 0 Part I, Line 1a The spending account is for a continuing medical education allowance. The doctors have an allowance of $4,000 per year for their continuing education. The board provides direction on the CME allowance. Review of the allowance is completed during each recruitment phase. An estimate is determined by the board based on a reasonable estimate provided by the recruiters. Total expenditures per person are reviewed and examined on an industry standard basis. These numbers are reevaluated each time a new doctor is recruited. Dr. Rotering and Jesse Mitchell live in a Tioga Medical Center apartment. The organization did include this as a taxable benefit income on their W-2. Lori Olson Family of President/CEO Ryan Mickelsen and Board Member Lee Olson 91436 Lori receives compensation as a registered nurse. 0 Marissa Mickelsen Family of President/CEO Ryan Mickelsen and Board Member Lee Olson 78477 Marissa receives compensation as an RHIT Medical Records Director. 0 Anna Nordloef Family of board member Seth Wisthoff 53010 Anna receives compensation as a registered nurse. 0 Hannah Valliere Family of board member Brodie Odegaard 79386 Hannah receives compensation as an IT Employee. 0 Form 990, Part VI, Section A, line 1a Board Chair does not vote. Form 990, Part VI, Section A, line 2 Brodie Odegaard and Holly Bryant - Family Relationship Form 990, Part VI, Section A, line 6 An individual interested in becoming a member must complete an application and submit to the Board of Directors for approval. There is only one class. Form 990, Part VI, Section A, line 7a An annual meeting is held in March of each year in which the members may elect board members if applicable. The members also vote on approval of the audited financial statements. Form 990, Part VI, Section A, line 8b The Physician Interview Committee does not take minutes as the committee meets only for physician interviews. This committee reports their recommendation to the full Board of Directors. Form 990, Part VI, Section B, line 11b A copy of the return is given to each board member and discussed at a regular monthly meeting. The board must approve the form before it is signed by the facility's representative. Form 990, Part VI, Section B, line 12c The policy covers all board members and officers. The Administration will determine if a conflict exists. In the event of a conflict, said board members abstain from related motions/votes but may still participate in discussions. Form 990, Part VI, Section B, line 15 Annual salary survey results from the North Dakota Hospital Association are reviewed. Related organization's 990 compensation information is also reviewed. The compensation of the President/CEO and Vice President/CFO and relevant employees is examined by the Board of Directors and adjusted annually if deemed necessary. This process is documented in the board minutes. Form 990, Part VI, Section C, line 19 The governing documents, conflict of interest policy and financial statements are available to the public upon request. Form 990, Part IX, line 11g Contract Labor: Program service expenses 1,757,889. Management and general expenses 0. Fundraising expenses 0. Total expenses 1,757,889. Purchased Services: Program service expenses 333,765. Management and general expenses 0. Fundraising expenses 0. Total expenses 333,765. Physician Fees: Program service expenses 36,404. Management and general expenses 0. Fundraising expenses 0. Total expenses 36,404. Other Fees: Program service expenses 363,498. Management and general expenses 0. Fundraising expenses 0. Total expenses 363,498.