2025-03-24T13:19:54-05:00 2024-06-30 161131146 BONADIO & CO LLP 171 SULLYS TRAIL PITTSFORD NY 14534 990 2023-07-01 450306787 CAVALIER COUNTY MEMORIAL HOSPITAL ASSOCIATION CAVA 7012566100 909 2ND ST LANGDON ND 58249 WAYNE REID CEO 7012566100 2025-03-24 1 1 AIMEE JOZIC P01329472 5853811000 2025-03-24 2023 2025-03-06 01:10:19Z LANGDON PRAIRIE HEALTH WAYNE REID 909 2ND ST LANGDON ND 58249 14021254 0 X HTTPS://WWW.LPH.HOSPITAL/HOME X 1969 ND LPH IS DEDICATED TO EXCEL AT PROVIDING HIGH-QUALITY, COMPASSIONATE HEALTHCARE TO ALL WE SERVE. 7 7 100 7 0 0 72679 396122 13848087 13392815 -13512 45558 330150 186759 14237404 14021254 9932 7394 0 0 6016839 6125035 0 0 0 8099208 8135959 14125979 14268388 111425 -247134 18667941 16397218 1738497 2137913 16929444 14259305 STANDING PROUDLY ON THE TRADITIONS AND PERSEVERANCE OF OUR HOSPITAL FOUNDERS, LPH IS DEDICATED TO EXCEL AT PROVIDING HIGH-QUALITY, COMPASSIONATE HEALTHCARE TO ALL WE SERVE. 0 0 10881414 7394 13392815 PROVIDE PATIENT HEALTHCARE SERVICES INCLUDING HOSPITAL AND CLINIC SERVICES TO THE SURROUNDING COMMUNITY. THE ORGANIZATION PROVIDED APPROXIMATELY $58,000 OF CHARITY CARE DURING THE YEAR ENDED 06/30/2024. 10881414 1 1 0 0 0 0 0 0 0 0 1 0 0 0 1 0 1 0 0 0 0 0 0 0 0 0 1 1 0 1 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 42 0 1 100 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 X 7 7 0 0 0 0 1 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 ND X MARI CHAMBERS 7012566100 909 2ND ST LANGDON ND 58249 JAY DUBOIS PRESIDENT 2.00 X X 0 0 0 SHERRY BUCHWEITZ SECRETARY 2.00 X X 0 0 0 KATHRYN KOPF VICE PRESIDENT 1.00 X X 0 0 0 STEVE HART TREASURER 1.00 X X 0 0 0 RUNA ANDERSON DIRECTOR 1.00 X 0 0 0 CHYRISSE REGEHR DIRECTOR 1.00 X 0 0 0 JACKIE DVORAK DIRECTOR 1.00 X 0 0 0 RICHARD WAYNE REID CEO BEGINNING NOV 2023 40.00 X 74574 0 18604 MICHELLE SKILLINGS CNO 40.00 X 90381 0 5996 MARGARET FONTANA CFO UNTIL NOVEMBER 2023 40.00 X 193650 0 11839 DARLA RODER INTERIM CEO UNTIL 10/23 AND COO 40.00 X 219864 0 19548 JOSEPH SANDERS AMBULANCE DIRECTOR 40.00 X 121654 0 9384 COURTNEY FEIL-SHORT NURSE PRACTITIONER 40.00 X 166324 0 761 CATHERINE TAYLOR PHARMACY DIRECTOR 40.00 X 135789 0 15590 1002236 0 81722 11 0 1 0 NATIONAL MEDICAL RESOURCES INC 2792 E BROADWAY AVE BISMARCK ND 58501 776142 SANFORD HEALTH 1305 W 18TH ST SIOUX FALLS SD 57117 669242 CARDINAL HEALTH 110 LLC 7000 CARDINAL PLACE DUBLIN OH 43017 615263 JOHNSON CONTROLS INC DEPT CH 10320 PALATINE IL 60055 538715 MEDICAL STAFFING PARTNERS INC 880 SW 15TH ST FOREST LAKE MN 55025 457053 26 347734 48388 396122 NET PATIENT REVENUE 621400 12413560 12413560 340B PHARMACY REVENUE 621400 815069 815069 LANGDON COUNTY AMBULANCE 621910 164186 164186 13392815 45558 45558 31845 0 31845 31845 31845 OTHER 900099 154914 154914 154914 14021254 13392815 0 232317 7394 7394 1067611 854089 213522 4160032 3312396 847636 65661 52529 13132 457321 365857 91464 374410 299528 74882 25780 12051 13729 74217 74217 26192 16900 9292 90621 90621 50395 30545 19850 463823 463823 187136 130486 56650 43065 36884 6181 28941 22863 6078 1037342 819500 217842 111443 1193 110250 CONTRACTED SERVICES 1775138 1591779 183359 FEES 1152933 1152933 PURCHASED SERVICES 983459 585090 398369 OTHER 772332 600868 171464 1313142 988529 324613 14268388 10881414 3386974 0 2222758 4507602 2073506 1649673 262959 168072 242040 220501 13109612 6250724 7372006 6858888 2706700 2702618 2492861 0 1295111 289864 18667941 16397218 864059 911348 447066 229462 427372 997103 1738497 2137913 X 14436583 14259305 2492861 0 16929444 14259305 18667941 16397218 X -247134 356144 -2492861 -286288 X X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 13167 13167 9301463 1631029 7670434 106708 1458600 -1351892 3523173 3161095 362078 165101 165101 6858888 DUE TO THIRD PARTY PAYABLES 834043 LEASE LIABILITY 163060 997103 14091110 356144 356144 13734966 286288 286288 14021254 14268388 0 14268388 0 14268388 PART XI, LINE 4B - OTHER ADJUSTMENTS: LOSS ON WRITE-OFFS OF ASSETS 1 1 X 0 0 1 1 0 1 1 557065 514979 42086 0.00290 557065 514979 42086 0.00290 4376 4376 0.00030 4376 4376 0.00030 561441 514979 46462 0.00320 1 314675 6648321 6600799 47522 X 1 1 1 1 CAVALIER COUNTY MEMORIAL HOSPITAL 909 2ND STREET LANGDON ND 58249 WWW.LPH.HOSPITAL 5029 X X X X CAVALIER COUNTY MEMORIAL HOSPITAL 1 0 0 1 X X X X X X X X X 22 1 0 1 1 X SEE SUPPLEMENTARY INFO. X 1 22 1 HTTPS://WWW.LPH.HOSPITAL 0 1 X 100.000000000000 200.000000000000 X X X X 0 1 X X X 1 X HTTPS://WWW.LPH.HOSPITAL X HTTPS://WWW.LPH.HOSPITAL X HTTPS://WWW.LPH.HOSPITAL X X X X X X 1 X 0 X X X X X 1 X 0 0 CAVALIER COUNTY MEMORIAL HOSPITAL PART V, SECTION B, LINE 5: THE METHODOLOGY TO CONDUCT THIS ASSESSMENT TAKES A COMPREHENSIVE APPROACH TO ASSESS COMMUNITY HEALTH NEEDS, PERFORM SEVERAL INDEPENDENT DATA ANALYSES BASED ON SECONDARY SOURCE DATA, AUGMENT THIS WITH LOCAL EXPERT ADVISOR OPINIONS, AND RESOLVE ANY DATA INCONSISTENCY OR DISCREPANCIES BY REVIEWING THE COMBINED OPINIONS FORMED FROM LOCAL EXPERT ADVISORS. THE HOSPITAL RELIES ON SECONDARY SOURCE DATA, AND MOST SECONDARY SOURCES USE THE COUNTY AS THE SMALLEST UNIT OF ANALYSIS. LOCAL EXPERT AREA RESIDENTS WERE ASKED TO NOTE IF THEY PERCEIVED THE PROBLEMS OR NEEDS IDENTIFIED BY SECONDARY SOURCES EXISTED IN THEIR PORTION OF THE COUNTY. NPUT WAS OBTAINED FROM THE REQUIRED THREE MINIMUM SOURCES AND EXPANDED TO INCLUDE OTHER REPRESENTATIVE GROUPS. THE HOSPITAL ASKED ALL THOSE PARTICIPATING IN THE WRITTEN COMMENT SOLICITATION PROCESS TO SELF-IDENTIFY INTO ANY OF THE FOLLOWING REPRESENTATIVE CLASSIFICATIONS, WHICH ARE DETAILED IN AN APPENDIX TO THIS REPORT. CAVALIER COUNTY MEMORIAL HOSPITAL PART V, SECTION B, LINE 6B: CAVALIER COUNTY MEMORIAL HOSPITAL CONDUCTED A COMMUNITY HEALTH NEEDS ASSESSMENT WITH QHR HEALTH.PART V, LINE 7A:HTTPS://WWW.LPH.HOSPITAL/COMMUNITY-HEALTH-NEEDS-ASSESSMENTPART V, LINE 10:HTTPS://WWW.LPH.HOSPITAL/COMMUNITY-HEALTH-NEEDS-ASSESSMENT CAVALIER COUNTY MEMORIAL HOSPITAL PART V, SECTION B, LINE 11: THE 2022 SIGNIFICANT HEALTH NEEDS IDENTIFIED FOR CAVALIER COUNTY ARE:1. BEHAVIORAL HEALTH:A. HOSPITAL SERVICES, PROGRAMS, AND RESOURCES AVAILABLE TO RESPOND TO THIS NEED INCLUDE:BEHAVIORAL MENTAL HEALTH TASK FORCE A LOCAL GROUP THAT CONSISTS OF REPRESENTATIVES FROM PUBLIC HEALTH, LAW ENFORCEMENT, SOCIAL SERVICES, THE BOARD OF EDUCATION, AND LPH; DEPRESSION SCREENINGS ARE PERFORMED DURING EVERY VISIT AT THE PRIMARY CARE CLINIC; TELE-PSYCHIATRY OFFERINGS.B. IMPACT OF ACTIONS TAKEN SINCE THE IMMEDIATE PRECEDING CHNA: ALCOHOLICS ANONYMOUS (AA) SERVICES ARE NOW PROVIDED AT WALHALLA CLINIC; LPH HAS A PROVIDER TRAINED IN CHILD BEHAVIORAL HEALTH; WALHALLA CLINIC OFFERS A ROBUST MEDICAL MARIJUANA PROGRAM TO LIMIT OPIOID USE AMONG CHRONIC PAIN PATIENTS.C. ADDITIONALLY, THE HOSPITAL PLANS TO TAKE THE FOLLOWING STEPS TO ADDRESS THIS NEED:ADD ALCOHOLICS ANONYMOUS/NARCOTICS ANONYMOUS (AA/NA) SERVICES;INCREASE EDUCATION AND AWARENESS ON MENTAL HEALTH IN THE COMMUNITY; WORK WITH ADDICTION COUNSELORS IN THE AREA TO CONNECT AA/NA PARTICIPANTS WITH THEIR SERVICES; EXPLORE POTENTIAL SCREENING PROTOCOLS FOR DRUG/SUBSTANCE/ALCOHOL USE; INCREASE EDUCATION FOR PHYSICIANS TO BE AWARE OF COUNSELORS THAT THEY CAN REFER PATIENTS TO; CONTINUE WORK WITH THE BEHAVIORAL MENTAL HEALTH TASK FORCE; EXPLORE THE DEVELOPMENT OF A SUBOXONE TREATMENT PROGRAM THROUGH A CERTIFIED PROVIDER; DEVELOP AND SUPPORT PROVIDERS WHO ARE INTERESTED IN BEHAVIORAL HEALTH. 2. CHRONIC DISEASE MANAGEMENT:A. HOSPITAL SERVICES, PROGRAMS, AND RESOURCES AVAILABLE TO RESPOND TO THIS NEED INCLUDE: CARAVAN HEALTH COLLABORATIVE LPH ACCOUNTABLE CARE ORGANIZATION (ACO); COMPREHENSIVE PRIMARY CARE SERVICES; CHRONIC CARE MANAGEMENT SERVICES CHRONIC DISEASE PATIENTS RECEIVE PHONE CALLS EVERY OTHER WEEK FROM HEALTHCARE PROFESSIONALS TO REVIEW HOW THEIR CARE IS GOING; TRANSITIONAL CARE MANAGEMENT SERVICES PATIENTS DISCHARGED FROM THE HOSPITAL WITH A CHRONIC CONDITION RECEIVE A CALL TO ENSURE A FOLLOW-UP APPOINTMENT IS SCHEDULED AT THE CLINIC; LPH PROVIDERS CONDUCT ANNUAL WELLNESS VISITS; POPULATION HEALTH NURSE AVAILABLE ON STAFF; LPH CONDUCTS AN ANNUAL HEALTH FAIR WITH OVER 30 DIFFERENT VENDORS; LPH CONDUCTS WOMEN'S HEALTH DAY AND MEN'S HEALTH DAY TO PROVIDE SCREENING SERVICES; COVID-19 PREVENTION AND EDUCATION SERVICES; TELEMEDICINE APPOINTMENTS ARE AVAILABLE ACROSS A RANGE OF SERVICE LINES; CAVALIER COUNTY SENIOR MEALS AND SERVICES AND THE FOUNDATION PROVIDE FREE MEALS FOR TWO WEEKS AFTER DISCHARGE TO MEDICARE PATIENTS; SCREENING SERVICES: BLOOD PRESSURE MONITORING; BONE DENSITY TESTING; COLONOSCOPIES; DIABETES MANAGEMENT; DOT YEARLY PHYSICALS; LAB TESTING; MAMMOGRAPHY; SPORTS PHYSICALS; WELLNESS CHECK-UPS; VISITING OUTREACH PROVIDERS; CARDIOLOGY; DERMATOLOGY; OB/GYN; ONCOLOGY; ORTHOPEDICS; PAIN MANAGEMENT; GI.B. ADDITIONALLY, THE HOSPITAL PLANS TO TAKE THE FOLLOWING STEPS TO ADDRESS THIS NEED: WORK WITH COMMERCIAL INSURANCES TO BROADEN CHRONIC CARE MANAGEMENT SERVICES TO ALL PATIENTS; INCREASE EDUCATION AND AWARENESS AROUND CHRONIC DISEASES ON SOCIAL MEDIA; INITIATE COMMUNITY PARAMEDIC PROGRAM, INCLUDING DISEASE MONITORING AND MEDICATION MANAGEMENT FOR CHF AND COPD; EXPLORE POTENTIAL PROGRAMS TO PROVIDE CARE IN A PATIENT'S HOME AS AN ALTERNATIVE TO LONG-TERM CARE; EVALUATE THE POTENTIAL OF INCREASING SPECIALTY ROTATIONS FOR SERVICES THAT ARE HEAVILY UTILIZED.3. ACCESS TO HEALTHCARE SERVICES: A. HOSPITAL SERVICES, PROGRAMS, AND RESOURCES AVAILABLE TO RESPOND TO THIS NEED INCLUDE: WEEKEND CLINIC HOURS; 24-HOUR EMERGENCY CARE AND SWING BED SERVICES; TELEMEDICINE APPOINTMENTS ARE AVAILABLE ACROSS A RANGE OF SERVICE LINES; VISITING OUTREACH PROVIDERS; CARDIOLOGY; DERMATOLOGY; OB/GYN; ONCOLOGY; ORTHOPEDICS; PAIN MANAGEMENT; GI; FINANCIAL ASSISTANCE POLICY FOR PATIENTS UP TO 200% OF THE FEDERAL POVERTY LINE; PRICE TRANSPARENCY PRICE ESTIMATOR TOOL AVAILABLE ON THE HOSPITAL'S WEBSITE; SCREENING FOR FINANCIAL ASSISTANCE POLICY IS INCLUDED ON ALL STATEMENTS AND APPLICATIONS ARE INCLUDED WITH PATIENT PACKETS; BILLING SUPPORT STAFF AVAILABLE ONSITE AT LPH; SOCIAL WORKER ON STAFF TO HELP CONNECT PATIENTS TO AVAILABLE RESOURCES; HOSPITAL-BACKED LOANS FOR PATIENTS THROUGH CHOICE FINANCIAL BANK; FREE HEALTH SCREENINGS FOR EMPLOYEES DURING HEALTHCARE WORKER APPRECIATION WEEK; OUTREACH CLINIC IN WALHALLA; LPH CONDUCTS AN ANNUAL HEALTH FAIR WHERE FREE HEALTH SCREENINGS ARE PROVIDED; AGREEMENT WITH THE UNIVERSITY OF NORTH DAKOTA TO TRAIN AND RECRUIT MEDICAL, NURSING, AND PHYSICIAN ASSISTANT STUDENTS; ON THE HORIZON: LPH'S COMMUNITY MAGAZINE PROVIDES STORIES FROM PATIENTS AND FEATURES INFORMATION ABOUT HOSPITAL SERVICES AND HEALTH TIPS.B. IMPACT OF ACTIONS TAKEN SINCE THE IMMEDIATELY PRECEDING CHNA: UPDATED FINANCIAL ASSISTANCE POLICY; OPTIMIZED HOSPITAL WEBSITE TO BE MORE USER-FRIENDLY AND TO PROVIDE CLEAR INFORMATION ON SERVICES AVAILABLE; IMPROVED HOSPITAL SIGNAGE TO SUPPORT COMMUNITY AWARENESS AND WAYFINDING.C. ADDITIONALLY, THE HOSPITAL PLANS TO TAKE THE FOLLOWING STEPS TO ADDRESS THIS NEED: ADD EARLY AND LATE WEEKDAY HOURS AT THE CLINIC; CONTINUE TO EXPAND TELEMEDICINE OFFERINGS; CONTINUE TO IMPROVE BILLING PROCESSES AT THE HOSPITAL; CONTINUE TO INVEST IN THE LOCAL COMMUNITY FOR NURSING STAFF. CAVALIER COUNTY MEMORIAL HOSPITAL PART V, SECTION B, LINE 13B: PATIENTS WHO HAVE DIED AND HAVE NO ESTATE ARE DEEMED BY CCMH TO HAVE NO INCOME FOR THE PURPOSE OF DETERMINING CHARITY CARE ELIGIBILITY. CAVALIER COUNTY MEMORIAL HOSPITAL PART V, SECTION B, LINE 16J: THE ORGANIZATION DID NOT TRANSLATE THE FAP INTO ANY OTHER LANGUAGE THAN THE ENGLISH. THERE IS LESS THAN 4% NON-ENGLISH SPEAKING POPULATION IN THE AREA THE HOSPITAL SERVES AND THERE IS NOT A REQUIREMENT TO TRANSLATE THE FAP.PART V, LINE 16A, FAP WEBSITE:HTTPS://WWW.LPH.HOSPITAL/INSURANCE-ASSISTANCEPART V, LINE 16B, FAP APPLICATION WEBSITE:HTTPS://WWW.LPH.HOSPITAL/INSURANCE-ASSISTANCEPART V, LINE 16C, FAP PLAIN LANGUAGE SUMMARY WEBSITE:HTTPS://WWW.LPH.HOSPITAL/INSURANCE-ASSISTANCE CAVALIER COUNTY MEMORIAL HOSPITAL PART V, SECTION B, LINE 20E: ALL PATIENTS RECEIVE LETTERS AFTER NONPAYMENT THAT INCLUDE A PLAIN LANGUAGE SUMMARY OF OUR FINANCIAL ASSISTANCE PLAN. 2 1 - LANGDON CLINIC 909 2ND STREET LANGDON ND 58249 OUTPATIENT PHYSICIAN CLINIC - RURAL HEALTH CLINIC 2 - WALHALLA CLINIC 301 5TH STREET WALHALLA ND 58282 OUTPATIENT PHYSICIAN CLINIC - RURAL HEALTH CLINIC PART III, LINE 2: THE ORGANIZATION'S BAD DEBT EXPENSE IS THE BAD DEBT EXPENSE LESS BAD DEBT RECOVERIES AS REPORTED ON THE FINANCIAL STATEMENTS MULTIPLIED BY THE COST TO CHARGE RATIO. PART III, LINE 3: THE ORGANIZATION HAS A VERY ROBUST FINANCIAL ASSISTANCE PROGRAM; THEREFORE, NO ESTIMATE IS MADE FOR BAD DEBT ATTRIBUTED TO FINANCIAL ASSISTANCE ELIGIBLE PATIENTS. PART III, LINE 4: GENERALLY, PATIENTS WHO ARE COVERED BY THIRD-PARTY PAYORS ARE RESPONSIBLE FOR RELATED DEDUCTIBLES AND COINSURANCE, WHICH VARY IN AMOUNT. THE HOSPITAL ALSO PROVIDES SERVICES TO UNINSURED PATIENTS AND OFFERS THOSE UNINSURED PATIENTS A DISCOUNT, EITHER BY POLICY OR LAW, FROM STANDARD CHARGES. THE HOSPITAL ESTIMATES THE TRANSACTION PRICE FOR PATIENTS WITH DEDUCTIBLES AND COINSURANCE AND FOR THOSE WHO ARE UNINSURED BASED ON HISTORICAL EXPERIENCE AND CURRENT MARKET CONDITIONS. THE INITIAL ESTIMATE OF THE TRANSACTION PRICE IS DETERMINED BY REDUCING THE STANDARD CHARGE BY ANY CONTRACTUAL ADJUSTMENTS, DISCOUNTS, AND IMPLICIT PRICE CONCESSIONS. SUBSEQUENT CHANGES TO THE ESTIMATE OF THE TRANSACTION PRICE ARE GENERALLY RECORDED AS ADJUSTMENTS TO PATIENT SERVICE REVENUE IN THE PERIOD OF THE CHANGE. SUBSEQUENT CHANGES THAT ARE DETERMINED TO BE THE RESULT OF AN ADVERSE CHANGE IN THE PATIENT'S ABILITY TO PAY ARE RECORDED AS BAD DEBT EXPENSE. CREDIT LOSS EXPENSE FOR THE YEARS ENDED JUNE 30, 2024 WAS NOT SIGNIFICANT.CONSISTENT WITH THE HOSPITAL'S MISSION, CARE IS PROVIDED TO PATIENTS REGARDLESS OF THEIR ABILITY TO PAY. THEREFORE, THE HOSPITAL HAS DETERMINED IT HAS PROVIDED IMPLICIT PRICE CONCESSIONS TO UNINSURED PATIENTS AND PATIENTS WITH OTHER UNINSURED BALANCES (I.E., COPAYS AND DEDUCTIBLES). THE IMPLICIT PRICE CONCESSIONS INCLUDED IN ESTIMATING THE TRANSACTION PRICE REPRESENT THE DIFFERENCE BETWEEN THE AMOUNTS BILLED TO PATIENTS AND THE AMOUNTS THE HOSPITAL EXPECTS TO COLLECT BASED ON ITS COLLECTION HISTORY WITH THOSE PATIENTS. THE HOSPITAL'S POLICY IS TO PROVIDE DISCOUNTS RANGING FROM 20 TO 100 PERCENT UNDER A SLIDING FEE SCHEDULE THAT IS BASED ON FAMILY SIZE AND INCOME IN RELATION TO FEDERAL POVERTY GUIDELINES. THIS POLICY DID NOT CHANGE IN 2024. PART III, LINE 9B: IF A PATIENT QUALIFIES FOR CHARITY CARE, A PERCENTAGE OF THEIR BILL IS WRITTEN OFF DEPENDING ON THEIR INCOME LEVEL. THE BALANCE THAT REMAINS IS SUBJECT TO OUR COLLECTION POLICY. IF A PAYMENT HAS NOT BEEN MADE FOR 2 MONTHS, A 1ST LETTER IS SENT STATING THAT THEY HAVE A MONTH TO MAKE A PAYMENT. IF A PAYMENT HAS NOT BEEN MADE AFTER THAT MONTH, A 2ND LETTER IS SENT OUT STATING THEY HAVE ANOTHER MONTH TO MAKE A PAYMENT. IF A PAYMENT HAS STILL NOT BEEN MADE, THEN THEY ARE TURNED OVER TO OUR COLLECTION AGENCY. PART III, LINE 3 THE ORGANIZATION HAS A VERY ROBUST FINANCIAL ASSISTANCE PROGRAM; THEREFORE, NO ESTIMATE IS MADE FOR BAD DEBT ATTRIBUTED TO FINANCIAL ASSISTANCE ELIGIBLE PATIENTS. PART VI, LINE 2 LANGDON PRAIRIE HEALTH ACTIVELY ASSESSES THE HEALTH CARE NEEDS OF THE COMMUNITY BY EVALUATING THE PROGRESS AND SUCCESS OF PREVIOUS COMMUNITY NEEDS ASSESSMENTS, EVALUATING QUALITY METRICS, PATIENT SATISFACTION SURVEYS, AND ACO RESULTS. ALL DEPARTMENTS PARTICIPATE IN LPH'S QUALITY ASSURANCE PROGRAM WHICH MEASURES PATIENT SATISFACTION AND THE QUALITY OF THE SERVICES PROVIDED AND PROVIDES AN OPPORTUNITY FOR IMPROVING PROCESSES RESULTING IN IMPROVED HEALTHCARE FOR OUR COMMUNITY. PART VI, LINE 3 LANGDON PRAIRIE HEALTH OFFERS ASSISTANCE TO ALL PATIENTS THAT ARE ELIGIBLE FOR FINANCIAL ASSISTANCE. OUR WEBSITE, FACEBOOK PAGE, BILLING STATEMENTS COMMUNITY CALENDAR AND PATIENT HANDBOOK INDICATE WHO TO CONTACT IN ORDER TO APPLY. BUSINESS OFFICE STAFF ALSO MONITOR PATIENT ACCOUNTS THAT ARE DORMANT AND IN JEOPARDY OF COLLECTIONS, CONTACT THOSE PATIENTS AND OFFER ASSISTANCE IN THE APPLICATIONS PROCESS AS WELL. PART VI, LINE 4 CAVALIER COUNTY IS LOCATED IN THE STATE OF NORTH DAKOTA AND ACCORDING TO THE US CENSUS 2022 HAS A POPULATION OF APPROXIMATELY 3,362. PERSONS 65 YEARS AND OLDER MAKE UP 27.2% AND PERSONS UNDER 18% MAKE UP 29%. THE WHITE RACE MAKES UP APPROXIMATELY 96% WHILE THE HISPANIC OR LATINO MAKES UP 2.5. OF THE 1,153 HOUSEHOLDS THERE WERE 2.34 PERSONS LIVING IN EACH HOUSEHOLD. THE MEDIAN HOUSEHOLD INCOME WAS $60,284 AND 8% WERE CONSIDERED TO BE IN POVERTY. THE POPULATION PER SQUARE MILE IS 2.5 IN AN AREA OF 1,489. 6.3% PERSONS SUFFER FROM A DISABILITY AND 7.1% ARE UNINSURED. THE COUNTY WAS FOUNDED IN 1879 AND THE COUNTY SEAT IS LOCATED IN LANGDON. PART VI, LINE 5 LPH AND CLINICS FURTHER THEIR EXEMPT PURPOSE BY PROMOTING THE HEALTH OF THE COMMUNITY BY OFFERING SEVERAL PROGRAMS FOR FINANCIAL ASSISTANCE, OFFERING HEALTH FAIRS AND FREE AND REDUCED HEALTH ASSESSMENTS AND TESTING. CHARITY CARE IS OFFERED AND EMERGENCY SERVICES ARE PROVIDED REGARDLESS OF A PATIENT'S ABILITY TO PAY. ANY CONTRIBUTIONS MADE TO THE ORGANIZATION ARE TAX DEDUCTIBLE AND APPLIES FOR GRANTS TO PURCHASE NEEDED EQUIPMENT AND PROVIDE ADVANCED MEDICAL TRAINING. PART VI, LINE 7, REPORTS FILED WITH STATES ND 0 STUDENT LOAN REPAYMENT PROGRAM 1 7394 X X 0 0 0 0 0 0 0 0 0 DARLA RODER INTERIM CEO UNTIL 10/23 AND COO 219864 0 0 0 0 0 6882 0 12666 0 239412 0 0 0 MARGARET FONTANA CFO UNTIL NOVEMBER 2023 193650 0 0 0 0 0 5879 0 5960 0 205489 0 0 0 COURTNEY FEIL-SHORT NURSE PRACTITIONER 166324 0 0 0 0 0 0 0 761 0 167085 0 0 0 CATHERINE TAYLOR PHARMACY DIRECTOR 135789 0 0 0 0 0 0 0 15590 0 151379 0 0 0 A CITY OF LANGDON NORTH DAKOTA 456002108 515679AL2 2010-03-25 2500000 HOSPITAL RENOVATION PROJECT 0 0 0 A 2265000 2500000 50000 2450000 0 0 1 1 A 0 0 0 0 0 0 0 A 0 1 0 0 0 0 0 0 0 FORM 990, PART VI, SECTION A, LINE 6 THE ORGANIZATION HAS ONE CLASS OF MEMBERS. A MEMBER OF THE CORPORATION IS SOMEONE 18 YEARS OF AGE OR OLDER AND RESIDING IN THE CORPORATION'S SERVICE AREA (50 MILE RADIUS). A MEMBER MUST APPLY AND THE BOARD OF TRUSTEES HAS THE POWER TO REVIEW ELIGIBILITY AS APPROPRIATE. ONCE A MEMBER, THE PERSON HAS THE RIGHT TO ATTEND THE ANNUAL MEETING (NOVEMBER), RECEIVE A COPY OF THE ANNUAL REPORT AND VOTE ON MATTERS BROUGHT TO THE MEMBERS BY THE BOARD OF TRUSTEES. MEMBERS DO NOT VOTE ON THE BOARD OF TRUSTEES POSITIONS. FORM 990, PART VI, SECTION B, LINE 11B FORM 990 IS FIRST REVIEWED BY THE CHIEF FINANCIAL OFFICER. THE FINANCE COMMITTEE WILL LOOK AT THE RETURN FOLLOWING THE CFO. FINALLY, THE BOARD OF DIRECTORS WILL RECEIVE AN ELECTRONIC COPY OF THE FORM 990 PRIOR TO FILING WITH THE IRS. FORM 990, PART VI, SECTION B, LINE 12C DIRECTORS, OFFICERS, AND TRUSTEES OF THE ORGANIZATION ARE COVERED UNDER THE CONFLICT OF INTEREST POLICY. POTENTIAL OR POSSIBLE CONFLICTS OF INTEREST ARE REVIEWED AT THE BOARD LEVEL AND A DETERMINATION IS MADE. RESTRICTIONS AND/OR ADJUSTMENTS ARE DETERMINED AND THEN IMPLEMENTED PER BOARD DIRECTION. RESTRICTIONS AND/OR ADJUSTMENTS ARE DOCUMENTED WITHIN THE BOARD MINUTES. IF ANY VARIANCES OF THE CONFLICT IN QUESTION ARE DISCOVERED THE BOARD WILL MAKE A DETERMINATION ON THE ACTION TO BE TAKEN. ANY POTENTIAL CONFLICT OF INTEREST ON THE PART OF ANY MEMBER OF THE BOARD OF DIRECTORS SHALL BE DISCLOSED IN WRITING TO THE BOARD AND MADE A MATTER OF RECORD THROUGH AN ANNUAL DISCLOSURE AND ALSO WHEN THE INTEREST INVOLVED A SPECIFIC ISSUE OR TRANSACTION BEFORE THE BOARD. IF A CONFLICT ARISES AFTER A MEMBER HAS COMPLETED THE DISCLOSURE, THE MEMBER SHOULD COMPLETE AN AMENDED DISCLOSURE INCLUDING THE NEW CONFLICT. IF AN INDIVIDUAL HAS A CONFLICT OF INTEREST, THE ENTIRE BOARD OF DIRECTORS VOTES ON APPROVAL OR DISAPPROVAL OF THE TRANSACTION. THE MEMBER INVOLVED IN THE TRANSACTION REFRAINS FROM VOTING OR OTHERWISE ATTEMPTING TO EXERT ANY INFLUENCE ON THE OTHER MEMBERS THAT WILL AFFECT THEIR DECISION ON THE ISSUE. FORM 990, PART VI, SECTION B, LINE 15 THE PROCEDURE THAT CCMH UTILIZES TO DETERMINE ITS CEO'S COMPENSATION IS AS FOLLOWS. UPON EXPIRATION OF CEO'S CONTRACT, THE CCMH BOARD OF DIRECTORS (BOD) CALLS FOR AN EXECUTIVE SESSION TO DISCUSS THE CEO'S CONTINUED/DISCONTINUED EMPLOYMENT. UPON APPROVAL TO CONTINUE THE CEO'S EMPLOYMENT, THE BOD PRESENTS AND REVIEWS THE CURRENT NORTH DAKOTA PREVAILING WAGE DATA COMMENSURATE WITH CEO JOB DESCRIPTION. ONCE AN APPROPRIATE COMPENSATION FIGURE HAS BEEN NEGOTIATED AND ACCEPTED BY THE CEO, THE BOD PASSES A MOTION TO RATIFY THE COMPENSATION AGREEMENT BETWEEN THE BOD AND CEO. FINALLY, REQUIRED DELIVERABLES AND OTHER MEASURABLE INDICATORS ARE MEMORIALIZED IN A FORMAL AGREEMENT OR CONTRACT WITH THE CEO. THE PROCEDURES UTILIZED BY CCMH TO SET WAGES FOR SUBORDINATE OFFICERS AND ALL OTHER EMPLOYEES IS DETERMINED BY THE CEO WHO IS EMPOWERED BY THE BOD TO DO SO. THE CEO REVIEWED THE CURRENT NORTH DAKOTA JOB SERVICE EDITION AND NORTH DAKOTA HEALTHCARE ASSOCIATION WAGES/SALARY ADJUSTMENTS OF SUBORDINATE OFFICERS AND EMPLOYEES IS SUPPLIED TO THE BOARD UPON REQUEST. FINALLY, THE APPROPRIATE COMPENSATION AND OTHER DELIVERABLES ARE MEMORIALIZED IN A FORMAL OFFER LETTER EXTENDED TO THE EMPLOYEE. FORM 990, PART VI, SECTION C, LINE 19 CAVALIER COUNTY MEMORIAL HOSPITAL MAKES THEIR GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. THE FINANCIAL STATEMENTS ARE ALSO PRESENTED ANNUALLY AT THE PUBLIC MEMBERS' MEETING. FORM 990, PART XI, LINE 9: LOSS ON WRITE-OFF OF ASSETS -286,288. FORM 990, PART XII, LINE 2C THE PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR.