2024-05-02T16:30:09-05:00 2023-06-30 450250958 Eide Bailly LLP 1730 Burnt Boat Loop Ste 100 Bismarck ND 585030886 990 2022-07-01 450425948 Towner County Medical Center Inc TOWN 7019684411 Highway 281 North Box 688 Cando ND 58324 Tammy Larson CFO 7019684411 2024-04-29 1 Tammy Larson 999009999 1 Lisa Chaffee CPA P00193453 7012551091 2024-04-29 2 AAL1 IAL1 2022 2023-04-26 12:10:37Z Ben Bucher Highway 281 North Box 688 Cando ND 58324 16288598 0 X www.tcmedcenter.org X 1992 ND To acquire, maintain and further develop hospital, clinical, long term care, and other services in Cando and the surrounding area. 7 7 152 7 0 0 2995503 2955275 12612537 13108567 10586 224 -528 212314 15618098 16276380 2975417 1411583 0 0 6702061 6891918 0 0 0 5608912 7182021 15286390 15485522 331708 790858 11055433 10450115 4874704 3478528 6180729 6971587 X Total quality comprehensive healthcare. Caring and compassionate health services for patients, residents, families and healthcare workers. Medical care for all life stages delivered by a professional and expert healthcare team. Commitment to our communities to maintain and ensure the ongoing provision of quality health services. The vision of Towner County Medical Center is to be the healthcare resource of choice for those who seek comprehensive quality health services. 0 0 12670641 1411583 13324104 I. IntroductionTowner County Medical Center was acquired from the Sisters of St. Francis, a Catholic religious order, in 1992. The community of Cando wanted to ensure itself that there would continue to be health care services available to not only the residents of Cando, but to the areas surrounding the community as well.Service to the community and the surrounding area is a hallmark of how we are here. The Medical Center provides diagnostic and therapeutic treatment to all, regardless of race, sex, religion, financial ability to pay, or any other area that could be deemed to be discriminatory. In addition to the core medical services, we are continually reaching out to surrounding communities assisting them in promoting a healthier community as well.II. Uncompensated CareTowner County Medical Center provides uncompensated care to those in need of services, who either have limited resources or who may have fallen on hard times and are in need of relief in order to get back on their feet. The amount of traditional uncompensated care for the year ended June 30, 2023 was $237,500, which includes charity care and implicit price concessions. In many cases, we believe that the bad debt is in fact charity care, but individuals are too proud to come in and request charity. New policies and procedures have been developed in an effort to allow us to better identify these individuals, and to be able to classify them as they should be. In addition to uncompensated care, Towner County Medical Center also provides discounts to the Medicare and Medicaid programs. For the year ended June 30, 2023 those discounts totaled $3,083,000. 12670641 1 1 0 0 0 0 0 0 1 0 1 0 0 1 1 1 0 1 0 0 0 0 0 0 0 0 1 1 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 1 40 0 1 152 1 0 0 0 0 0 0 0 0 0 0 0 0 X 7 7 0 0 0 0 1 1 1 1 0 0 0 1 1 1 1 0 1 1 0 0 X Tammy Larson 7019682560 Highway 281 North Box 688 Cando ND 58324 David Wolsky President 1.00 0.50 X X 0 0 0 Tom Belzer Vice President 1.00 1.00 X X 0 0 0 Greg Westlind Secretary/Treasurer 1.00 0.50 X X 0 0 0 Randina Bjornstad Director 1.00 0.50 X 0 0 0 John Peters Director 1.00 0.50 X 0 0 0 Mike Farbo Director 1.00 0.50 X 0 0 0 Michelle Gibbens Director 1.00 0.50 X 0 0 0 Ben Bucher CEO 45.00 10.00 X 284936 0 21292 Tammy Larson CFO 45.00 10.00 X 188321 0 20315 Grant Lannoye Physician Assistant 45.00 0.00 X 241179 0 22386 Sam Held Family Nurse Practitioner 45.00 0.00 X 189713 0 20276 Jessica Larson Family Nurse Practitioner 45.00 0.00 X 156786 0 18450 Cassandra Ullyott Family Nurse Practitioner 45.00 0.00 X 144421 0 18451 Chet Yoder Physical Therapist 45.00 0.00 X 110055 0 8014 1315411 0 129184 7 0 1 0 Resolution RCM 1573 Mallory Lane - Ste 200 Brentwood TN 37027 Revenue Cycle Management 525035 Barton Healthcare Staffing PO Box 412801 Boston MA 02241 Contract Nursing 306127 DMS Health Technologies PO Box 670747 Dallas TX 75267 Imaging Services 227742 3 9710 2904730 40835 2955275 Net Patient Revenue 621110 9401864 9401864 Nursing Home Revenue 623000 3220221 3220221 Pharmacy Revenue 456110 76836 76836 Contracted Serv.-R/P 900099 51600 51600 358046 358046 13108567 224 224 5775 6051 -276 -276 -276 3220 9710 6167 -2947 -2947 Gain on extinguishment of liab. 900099 215537 215537 215537 16276380 13324104 0 -2999 X 1411583 1411583 574398 28720 545678 5106207 4750746 355461 111891 94599 17292 712236 545959 166277 387186 283954 103232 7763 7763 67490 67490 2988680 1965482 1023198 14840 14840 143892 78430 65462 240760 95777 144983 768564 762984 5580 14023 13584 439 53383 21395 31988 70889 56657 14232 683208 589984 93224 120908 120908 Medical Supplies 1618363 1618363 Food 157660 157660 Bad Debt 150000 150000 Subscriptions and Dues 66879 44714 22165 14719 50 14669 15485522 12670641 2814881 0 6146845 3323915 1450094 1490981 148800 148800 370673 291534 125607 129818 8452522 6197812 2795270 2254710 18144 0 2810357 11055433 10450115 1359358 1429347 100000 5006 5686 377951 154427 2877962 2043495 4874704 3478528 X 6180729 6971587 6180729 6971587 11055433 10450115 790858 0 X 0 1 X 0 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 1 X 3589403 2293396 1296007 4753923 3835238 918685 109196 69178 40018 2254710 Estimated Third Party Payor Settlements 206186 Employee Retention Credit 2604171 2810357 Related Party Payable 90001 Direct Financing Lease 1788097 Construction Payable 165397 2043495 X 16286446 -2152 -2152 16288598 -12218 -12218 16276380 15495588 12218 12218 15483370 2152 2152 15485522 Part IV, Line 2b: The Organization holds funds under an agency relationship for the residents of the long-term nursing care facility. These funds are included in cash with a corresponding liability in accounts payable. Funds held totaled $5,686 and $5,006 as of June 30, 2023 and 2022. Part X, Line 2: The Medical Center believes they have 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 2d - Other Adjustments: Interest Expense in Revenue on Financial Statements -2,152. Part XI, Line 4b - Other Adjustments: Rental Expenses Reported in Expenses on Financial Statements -6,051. Special Event Expenses -6,167. Part XII, Line 2d - Other Adjustments: Rental Expenses Reported in Expenses on Financial Statements 6,051. Special Event Expenses 6,167. Part XII, Line 4b - Other Adjustments: Interest Expense in Revenue on Financial Statements 2,152. 1 1 X 1 X 1 X 0 1 0 0 6000 6000 0.00040 2393401 2274165 119236 0.00770 2399401 2274165 125236 0.00810 31700 23700 8000 0.00050 26000 26000 0.00170 2433666 2234526 199140 0.01290 2491366 2258226 233140 0.01510 4890767 4532391 358376 0.02320 1 226639 22211 3694802 3712517 -17715 X 1 1 1 1 Towner County Medical Center Highway 281 North Box 688 Cando ND 58324 www.tcmedcenter.org 5061 X X X X One provider-based clinic Towner County Medical Center 1 0 0 1 X X X X X X X X X 21 1 0 1 1 X http://tcmedcenter.org/ X 1 21 1 http://tcmedcenter.org/ 0 1 X 100.000000000000 200.000000000000 1 1 X X X X 1 X https://tcmedcenter.org/resources/ X https://tcmedcenter.org/resources/ X https://tcmedcenter.org/resources/ X X X X X X 1 X 0 X X X X 1 X 0 0 Towner County Medical Center Part V, Section B, Line 5: A survey was used to solicit feedback from area residents for the CHNA. This went out in December of 2021 and it was available for 4 months to complete. Community leaders, representing the broad interests of the community, took part in one-on-one key informant interviews. A community group, comprised of community leaders and area residents, was convened to discuss area health needs and inform of the assessment process. The first meeting was held in November of 2021 and various meetings, and one-on-one sessions were held over the next 6 months with an implementation plan brought to the community in July. The Center for Rural Health provided input as well as Towner County Public Health on the medically underserved, low-income and minority populations. Towner County Medical Center Part V, Section B, Line 6b: Towner County Public Health District Towner County Medical Center Part V, Section B, Line 11: The following needs were identified in the most recently completed CHNA:1. Mental Health Services2. Retaining Young Families3. Cost of Healthcare4. ChildcareTowner County Medical Center has been working to address each of these needs as follows:1. Mental Health Services: During the fiscal year, we continued to find ways to address the mental and emotional health issues that are present in the community. We are working together with Public Health, Law enforcement, and local schools to identify the specific needs for the area concerning mental and emotional health. Providers have implemented certain procedures in their regular clinic visits to let the patient know there are services available. 2. Retaining Young Families: TCMC continues to strive to keep our wages and benefits competitive so we are able to retain younger families in the area and they do not go elsewhere for work. We hold an annual "Scrubs Camp" each year for area high schools to draw an interest for the younger generation to get involved in the healthcare field and hopefully move back to the community and start a family. 3. Cost of Healthcare: We continue to provide preventative healthcare procedures and expand healthcare screening to area residents. Outreach professionals continue to bring healthcare to TCMC on a regular basis, allowing patients to stay close to home for the care they need. We will continue to look at ways to expand these services. 4. Childcare: We continue to operate childcare for the community even if it operates at a loss every year to the Medical Center. TCMC daycare is certified Step 4 with the Bright and Early program of North Dakota. Our Director continues to apply for grants to reduce the cost of labor so we are able to continue to provide affordable, high quality daycare in the area. Towner County Medical Center Part V, Section B, Line 16j: The financial assistance policy and application are available on the website and upon request. The financial assistance policy is provided in summary form with the third billing invoice. Towner County Medical Center also has a credit collection policy brochure posted at the clinic reception desk where patients check in. Part V, Line 20d: An application is required to be filled out and on file prior to a patient receiving financial assistance. 1 1 - Towner County Living Center Highway 281 North Box 688 Cando ND 58324 Licensed Nursing Home 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.Part I, Line 7b: The Medicaid cost report was used to calculate the amount of unreimbursed Medicaid.Part I, line 7e and 7f: Costs reported on line 7e and 7f come from the general ledger accounts. Part I, Line 7g: Towner County Medical Center operates the only emergency room in their service area. The cost for subsidizing health services was determined using the Medicare 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 and residents. Part III, Line 3: The methodology for determining the amount of the Organization's implicit price concessions attributable to patients that would be eligible under the Organization's charity care policy was calculated by taking the percentage of individuals below the poverty level times implicit price concessions. 9.8 percent of individuals are below the poverty level and so the organization is estimating that 9.8 percent of implicit price concessions is attributable to individuals eligible for charity care. Part III, Line 4: Footnote from organization's financial statements: The footnote that describes implicit price concessions is found on page 11-12 of the attached audit report. 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.Towner County Medical Center provides services to patients under the Medicare program knowing they will not recover all the costs associated with providing these services. Providing these services is essential to these patients and the community and increases their access to healthcare services. Therefore, the Medicare shortfall is considered a community benefit. Part III, Line 9b: After a patient receives two statements without making a payment, TCMC will call the patient to discuss their past due account. After the third statement is sent out the patient also receives a written notice saying they are being sent to collections. This notice also provides a number for them to contact TCMC about their past due account. If the patient does get in contact with TCMC they will offer the patient charity care at that time and the patient will need to complete the steps to see if they qualify for charity care. If an individual submits an incomplete financial assistance application, they are contacted regarding the missing information. They are not sent to collections until all of the information has been received and it is determined they do not meet the qualifications for financial assistance. If a person submits a financial assistance application after they have been sent to collections, and it is determined they are eligible for financial assistance, the accounts that qualify will be removed from collections. It is documented on the application submitted if a patient is eligible or ineligible for financial assistance. Part VI, Line 2: We completed a market analysis study that provided us with areas of concern as well as possible areas of growth. This will now be used for strategic planning in regards to what services may be feasible for Towner County Medical Center to pursue going forward.We are currently in the process of building a new hospital/clinic/nursing home. The goal is to have this new campus completed during the year 2024. Part VI, Line 3: Towner County Medical Center posts its charity care policy, or a summary thereof, financial assistance application and financial assistance contact information on their website and in admissions areas; includes the policy, or a summary thereof, along with financial assistance contact information in the patient's third billing invoice; and/or discusses with the patient the availability of various government benefits, such as Medicaid or state programs, and assists the patient with qualification for such programs, where applicable. Part VI, Line 4: The community Towner County Medical Center (TCMC) serves is rural with an estimated population of 2,162 people, 25.3% of this is senior population aged 65 and older. The median household income is $52,300 and the average household size is 2.07. Of this population, 9.8% live below the poverty level. There are two hospitals within 40-55 miles of Towner County Medical Center. One is in Rolla, which is within 10 miles from the Turtle Mountain Indian Reservation. The other is in Devils Lake which is within 10 miles from the Spirit Lake Indian Reservation. Part VI, Line 5: Towner County Medical Center's Board of Directors is comprised of volunteers that reside in the community. TCMC would extend medical privileges to all qualified physicians in the hospital to practice, although there are currently no other physicians in the community. Any surplus funds, if available, are used to improve patient care and add additional patient services. Recent additional services added have been CT and Outpatient Chemotherapy services.TCMC provides specialty cardiac rehab, cancer outpatient services, and operates an emergency room regardless of ability to pay. TCMC is the sole community provider of healthcare services in this community.Community outreach with Public Entities:Towner County was the last county in the state of North Dakota to not have a county public health office. In conjunction with the county, Towner County Medical Center took on the responsibility of starting up the public health office. The program, which is funded by Towner County and through grants, provides many services such as immunizations, baby checks, car seats and other services to those in need. It is through cooperation, such as this, that Towner County Medical Center is able to reach out and provide services to those most in need, who may not otherwise be able to receive these types of preventative services.Community Outreach for the Broader Community:Towner County Medical Center offers a number of services to individuals in the region aimed at providing preventative services, educational services and chronic care management services.Senior Meals/Senior Center - Towner County Medical Center provides senior meals. Seniors either come to the medical center to eat their lunches or they are taken out to them through the use of volunteers. In addition to the meals, Towner County Medical Center also offers its conference room as a gathering place for the seniors in the community and area to come socialize, play cards or to have other events. The use of the space is weekly and there is no cost to the seniors for the use of this space.Medical Education - Towner County Medical Center serves as an active participant in the University of North Dakota Medical School training program. Serving as a site for various medical students, we also serve as a clinical site for nurses in training, certified nursing assistant in training, and for other fields in which we have appropriately trained staff and facilities to assist in the training process.Other - We encourage physicians and other staff to be active participants in the community. We have staff actively involved in economic development, in youth sports, in the fine arts, and in community leadership positions. It is through this active partnership that Towner County Medical Center is able to contribute to the community to make it a better place to live and an area that people desire to move to. 1 Towner County Hospital Authority Highway 281 North Box 688 Cando ND 58324 450423303 501(c)(3) 1411583 0 Building New Hospital 1 0 Part I, Line 2: The Organization transferred construction in progress additions of $1,411,583 to Towner County Hospital Authority (TCHA). The construction in progress relates to a new hospital project. Upon completion of the new hospital, TCHA will retain all rights to the new hospital, and the Organization will enter into a lease agreement with TCHA for use of the new hospital as determined by the respective Boards of Directors. X X X X 0 0 0 0 0 0 0 0 0 Ben Bucher CEO 246436 0 38500 0 0 0 10193 0 11843 0 306972 0 0 0 Grant Lannoye Physician Assistant 185295 0 55884 0 0 0 10241 0 12814 0 264234 0 0 0 Sam Held Family Nurse Practitioner 153797 0 35916 0 0 0 8180 0 12840 0 210733 0 0 0 Tammy Larson CFO 166140 0 22181 0 0 0 7162 0 13897 0 209380 0 0 0 Jessica Larson Family Nurse Practitioner 141489 0 15297 0 0 0 6354 0 12840 0 175980 0 0 0 Cassandra Ullyott Family Nurse Practitioner 118231 0 26190 0 0 0 6305 0 12707 0 163433 0 0 0 Form 990, Part VI, Section A, line 6 The hospital is a membership corporation. The membership is made up of Class A members of the Towner County Hospital Authority. Form 990, Part VI, Section A, line 7a The Board of Directors is elected by the membership at its annual meeting. Form 990, Part VI, Section A, line 7b Amendments to the bylaws by a majority of the Board of Directors must be ratified by the Class A membership at the next succeeding annual meeting. Form 990, Part VI, Section A, line 8b There were no committees with authority to act on behalf of the full board. Form 990, Part VI, Section B, line 11b The CEO will review a draft of the 990. The 990 will be presented to the Board of Directors for their approval prior to filing with the Internal Revenue Service. Form 990, Part VI, Section B, line 12c The CEO, CFO and board members annually disclose any interests that could give rise to conflicts. The CEO reviews the responses. Any member of the Board of Directors having a conflict of interest on any matter should not vote or use his/her personal influence on the matter. The CEO and the CFO do not vote. If they have a conflict of interest they would be asked to leave the room when discussions were held related to the conflict. Any conflict of interest is disclosed and made a matter of record through an annual procedure approved by the Board of Directors. Form 990, Part VI, Section B, line 15a A review and evaluation are performed annually by the Board of Directors and an outside consultant for the CEO. Comparable compensation data are used for compensation and benefits. The CFO's compensation is approved annually by the CEO. 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. Form 990, Part IX, line 11g Contracted Services: Program service expenses 78,037. Management and general expenses 959,050. Fundraising expenses 0. Total expenses 1,037,087. Other Fees: Program service expenses 13,444. Management and general expenses 64,148. Fundraising expenses 0. Total expenses 77,592. Professional Fees: Program service expenses 1,874,001. Management and general expenses 0. Fundraising expenses 0. Total expenses 1,874,001. Towner County Living Center Highway 281 North PO Box 688 Cando ND 58324 450422204 Lease Nursing Home Facility ND 501(c)(3) Line 12b, II Towner County Medical Center Inc 1 Towner County Hospital Authority Highway 281 North PO Box 688 Cando ND 58324 450423303 Lease Hospital Facility ND 501(c)(3) Line 7 N/A 0 0 1 0 0 0 0 0 0 0 0 1 0 0 1 1 0 0 0 0 Towner County Living Center K 307300 General Ledger