2025-02-21T15:31:34-06:00 2024-06-30 450250958 Eide Bailly LLP 800 Nicollet Mall Ste 1300 Minneapolis MN 554027033 990 2023-07-01 450308484 Tioga Medical Center TIOG 7016643305 PO Box 159 Tioga ND 58852 Jamie Eraas President & CEO 7016643305 2025-02-21 1 1 Kim Hunwardsen CPA P00484560 6122536500 2025-02-21 2023 2025-03-06 01:10:19Z Jamie Eraas PO Box 159 Tioga ND 58852 18741614 0 X www.tiogahealth.org X 1960 ND Health care and nursing care services 9 6 180 150 0 0 3991674 674562 16239621 16921876 21166 261822 321314 859663 20573775 18717923 4500 500 0 0 9052805 9517183 0 0 0 7906613 8090230 16963918 17607913 3609857 1110010 25723240 26613457 7192435 6890153 18530805 19723304 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 8146606 10481773 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.Tioga Medical Center provides delivery of healthcare services over eastern Williams county, Burke County and western Mountrail county of the state of North Dakota.(continued on Schedule O)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 1,940 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, 2024 of approximately $36,000.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. 3073537 3917786 Attached to the CAH is a 30 bed skilled nursing facility (SNF). This facility provides skilled and long term care services to its residents. 3092364 2265068 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. 203239 500 257249 Finally, attached to the Nursing home is a 22 unit independent living unit. The organization also has a Foundation that distributes scholarships. 203239 500 257249 14515746 1 1 0 1 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 1 0 0 0 0 0 0 0 0 0 0 1 19 0 1 180 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 Kristopher Kuehn Director 0.50 X 0 0 0 Patrick Joyce Director 0.50 X 0 0 0 Jamie Eraas CEO 40.00 X 174044 0 6147 Holly Bryant CFO 40.00 X 95034 0 2737 Dr Robert Rotering Medical Director/Physician 40.00 X 426617 0 20817 Jeffrey Moberg Jr Physician Assistant 40.00 X 445396 0 38808 Jesse Mitchell Nurse Practitioner 40.00 X 204851 0 29009 Shelby Knox Physician Assistant 40.00 X 198288 0 25746 Nancy Carlson Nurse Practitioner 40.00 X 177821 0 15335 1722051 0 138599 11 0 1 0 Homestead Recruiters 821 Senior Ave Dickinson ND 58601 Contract Nursing 630834 Full Circle Staffing LLC 3602 7th Street West Apt 310 Williston ND 58801 Contract Nursing 189880 2 639661 34901 674562 Patient & Resident Revenue 621110 15795735 15795735 340B Pharmacy 456110 957457 957457 Other Revenue 900099 168684 168684 16921876 262127 262127 872379 872379 2700 15416 -12716 -12716 -12716 7970 8275 0 -8275 7970 -305 -305 18717923 16921876 0 1121485 X 500 500 325301 325301 256406 256406 7526376 5797685 1728691 25504 24356 1148 817974 606586 211388 565622 422407 143215 18162 18162 167437 167437 6520 6520 2417640 2402173 15467 27373 27373 454201 332827 121374 509428 484054 25374 412538 409741 2797 39652 20592 19060 74100 61100 13000 115100 115100 1188120 1134784 53336 123475 123475 Medical Supplies 1856866 1856866 Food 246208 246208 Repairs and Maintenance 246006 210573 35433 Dues and Subscriptions 65187 65187 122217 10313 111904 17607913 14515746 3092167 0 4592196 7490621 10695 2910059 3404750 94179 75401 133955 79544 26947906 16872198 10983216 10075708 3167735 4217798 3831205 1269635 25723240 26613457 934659 845558 10125 9480 5889561 5582955 358090 452160 7192435 6890153 X 18524305 19716804 6500 6500 18530805 19723304 25723240 26613457 1110010 82489 0 X 0 1 X 1 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 1974 1974 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 9681924 8606810 7954610 6613509 1341101 690509 576765 113744 10075708 Operating Lease Liability 155160 Estimated third-party payor settlements 297000 452160 X 18809308 82489 82489 18726819 6520 -15416 -8896 18717923 17616809 15416 15416 17601393 6520 6520 17607913 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 -15,416. Part XII, Line 2d - Other Adjustments: Rental Expenses 15,416. 1 1 X 1 X 110.000000000000 1 X 0 0 0 36000 36000 0.00200 2631337 2513920 117417 0.00670 2667337 2513920 153417 0.00870 3568 3568 0.00020 105165 105165 0.00600 3850545 3152437 698108 0.03960 3959278 3152437 806841 0.04580 6626615 5666357 960258 0.05450 1 995000 79600 4087164 4113553 -26389 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 on 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.Tioga Medical Center has created a partnership with the Tioga EDC and Mayo Clinic to bring a wellness program (Live Well Tioga) to our community. Live Well Tioga is a community health initiative that aims to provide residents with the wellness education and resources they need to live healthier, happier lives. We hold a free monthly lunch and learn event where experts from Mayo Clinic share with our community on topics ranging from meal planning and exercise to better sleep and stress management. 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 in the past several years. 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 has also worked hard to provide support services for our community after tragic community events have taken place in the past year. The most recent was a very large wildfire that affected many families throughout our community. ConnectUs Therapy opened their doors at Tioga Medical Center for several days following and provided free services for anyone that was impacted. 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 N 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.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. X 1 1 X X X 0 0 0 0 0 0 0 0 0 Jeffrey Moberg Jr Physician Assistant 443316 0 2080 0 0 0 9800 0 29009 0 484205 0 0 0 Dr Robert Rotering Medical Director/Physician 412397 0 14220 0 0 0 9876 0 10941 0 447434 0 0 0 Jesse Mitchell Nurse Practitioner 202771 0 2080 0 0 0 0 0 29009 0 233860 0 0 0 Shelby Knox Physician Assistant 196208 0 2080 0 0 0 6222 0 19524 0 224034 0 0 0 Nancy Carlson Nurse Practitioner 176157 0 1664 0 0 0 0 0 15335 0 193156 0 0 0 Jamie Eraas CEO 171964 0 2080 0 0 0 5238 0 910 0 180192 0 0 0 Part I, Line 1a Dr. Robert Rotering and Jesse Mitchell, FNP, both received a housing allowance. The organization did include this as a taxable benefit income on their W-2. Lori Olson Family of Board Member Lee Olson 58428 Employee compensation 0 Marissa Mickelsen Family of Board Member Lee Olson 60128 Employee compensation 0 Anna Nordloef Family of board member Seth Wisthoff 50943 Employee compensation 0 Hannah Odegaard Family of board member Brodie Odegaard 86907 Employee compensation 0 Form 990, Part VI, Section A, line 1a Board Chair only votes in the case of a tie. 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 There are no committee with the authority to act on behalf of the full board. 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. Similar 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 1,370,145. Management and general expenses 11,498. Fundraising expenses 0. Total expenses 1,381,643. Purchased Services: Program service expenses 395,528. Management and general expenses 0. Fundraising expenses 0. Total expenses 395,528. Physician Fees: Program service expenses 60,824. Management and general expenses 0. Fundraising expenses 0. Total expenses 60,824. Other Fees: Program service expenses 575,676. Management and general expenses 3,969. Fundraising expenses 0. Total expenses 579,645.