2021-05-03T14:45:32-05:00 2020-06-30 390758449 WIPFLI LLP 1502 LONDON ROAD SUITE 200 DULUTH MN 55812 990 2019-07-01 770637498 MCKENZIE COUNTY HEALTHCARE SYSTEMS INC MCKE 7018423000 709 4TH AVENUE NE WATFORD CITY ND 58854 DANIEL KELLY CEO 7018423000 2021-04-28 1 MICHAEL J PETERSON CPA P01833529 2187224705 2021-04-28 2019 2022-09-23 18:48:47Z DANIEL KELLY 709 4TH AVENUE NE WATFORD CITY ND 58854 38918819 0 X WWW.MCKENZIEHEALTH.COM X 2004 ND HEALTH CARE SERVICE PROVIDER. 9 9 294 50 324413 0 3155508 7573741 23686488 29544486 14735 20542 726853 753329 27583584 37892098 50 0 0 0 11260469 15652076 0 0 0 19555007 24123685 30815526 39775761 -3231942 -1883663 115957319 117929707 78862752 82718803 37094567 35210904 X MCKENZIE COUNTY HEALTHCARE SYSTEMS IS A FAITH-BASED ORGANIZATION DEDICATED TO PROFESSIONAL, COMPASSIONATE AND QUALITY HEALTHCARE. 1 1 23959917 0 21742416 MCKENZIE COUNTY HEALTHCARE SYSTEMS PROVIDES 24 HOUR X 7 DAYS A WEEK SERVICES. MCHS PROVIDED IN-PATIENT, OBSERVATION, AND SWING BED SERVICES - HOSPITAL- TOTAL INPATIENT/OBSERVATION DAYS - 646. TOTAL SWING BED DAYS - 421. MCHS OFFERS VARIOUS OTHER SERVICES. THEY OFFER ENDOSCOPIC EXAMS ONCE A MONTH BY A CONTRACTED PROVIDER. TOTAL OUTPATIENT SURGERIES - 255. THE EMERGENCY ROOM IS OPEN 24 HOURS A DAY, 7 DAYS A WEEK. TOTAL EMERGENCY ROOM VISITS - 5,157 THE LABORATORY IS LOCATED WITHIN THE HOSPITAL FACILITY. BIRTHDAY LAB SCREENINGS ARE AVAILABLE TO THE COMMUNITY AT THE HOSPITAL AT A REDUCED RATE. NUMBER OF MEMBERS TAKING ADVANTAGE OF BIRTHDAY SCREENINGS - 703. TOTAL OUTPATIENT PROCEDURES - 20,761. 5010218 0 4546520 THE MCKENZIE COUNTY HEALTHCARE SYSTEM (MCHS) GOOD SHEPHERD HOME (GSH) IS A 42 BED SKILLED NURSING HOME WITH AN ATTACHED 9-BED BASIC CARE UNIT. BASIC CARE WAS CLOSED DUE TO CONSTRUCTION IN FEBRUARY 2018 AND WILL REOPEN AT A LATER DATE. THE GSH OFFERS DAY CARE AND/OR RESPITE CARE FOR THOSE CARING FOR A LOVED ONE IN THEIR HOME. A DEMENTIA SUPPORT GROUP IS OFFERED TO FAMILIES. THEY MAINTAIN REGULAR RESIDENT FAMILY COUNCIL MEETINGS. ALONG WITH QUALIFIED NURSING CARE AND STAFF, SOCIAL SERVICES, PHYSICAL THERAPY, OCCUPATIONAL THERAPY, RESTORATION NURSING, LAUNDRY, HOUSEKEEPING, BEAUTICIAN SERVICES, AND ACTIVITY PROGRAMS ARE OFFERED (BEAUTICIAN AND ACTIVITIES HELD WHEN COVID CONDITIONS ALLOW). VISITORS ARE WELCOME WHEN COVID CONDITIONS ALLOW; REGULAR ELECTRONIC "VISITS" ARE ARRANGED OTHERWISE. PASTORAL CARE AND CHAPEL ARE OFFERED 7 DAYS A WEEK. ACTIVITIES INCLUDE BIRTHDAY PARTIES, MUSICAL GROUPS, BAKING, AND BUS TRIPS. THE SKILLED NURSING TOTAL PERCENT OF OCCUPANCY HAS BEEN 80.70%. THE BASIC CARE UNIT TOTAL PERCENT OF OCCUPANCY HAS BEEN 0% WHILE THE SPACE IS CLOSED. 3399608 0 3084973 THE MCHS CLINIC (RURAL HEALTH CLINIC) MAINTAINS THE SAME MISSION AS THE HOSPITAL. IT PROVIDES CARE MONDAY THROUGH FRIDAY. THE RHC RECENTLY STARTED CONDUCTING TELEHEALTH VISITS AS RENDERING PROVIDERS DUE TO COVID. A FULL-TIME CONTRACTED LOCUM PHYSICIAN GROUP PROVIDE EMERGENCY ROOM COVERAGE AT THE HOSPITAL 24 HOURS A DAY X 7 DAYS A WEEK AS WELL AS 7 DAY A WEEK URGENT CARE COVERAGE FROM 8A TO 8P UTILIZING MID-LEVEL PROVIDERS. AN RHC PROVIDER OFFERED REGULAR VISITS TO THE GOOD SHEPHERD HOME. BOTH THE VALUE BASED PROGRAM INVOLVEMENT AS WELL AS OUR VISITING NURSE PROGRAM HAVE BEEN A GREAT ASSET TO THE CLINIC, PROVIDING CARE TO HOMEBOUND PATIENTS WITHIN OUR COMMUNITY. AFTER THE ONSET OF THE COVID-19 PANDEMIC THE RHC DEVELOPED POINT-OF-CARE SERVICES AND RAPID TESTING FOR THE COMMUNITY. 229208 0 207995 HORIZON ASSISTED LIVING PROVIDES ASSISTED AND INDEPENDENT LIVING SERVICES. IT CONSISTS OF 15 APARTMENTS THAT PROVIDE A 24 HOUR CALL SYSTEM TO HEALTH CARE PERSONNEL. THE STAFF IS DEDICATED TO HELPING SENIORS LIVE AT THEIR HIGHEST LEVEL OF INDEPENDENCE AND ABILITY. ITS PERCENT OF OCCUPANCY IS CURRENTLY AT 57.20%. 394851 0 0 WELLNESS CENTER 624059 0 207995 32993802 1 1 0 1 0 0 0 0 0 0 1 0 0 1 1 0 0 1 0 0 0 0 0 0 0 0 1 1 0 0 1 0 0 0 1 0 0 1 0 0 0 0 0 0 1 1 1 0 0 1 56 0 294 1 1 1 0 0 0 0 0 0 0 0 0 0 0 X 9 9 1 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 X DANIEL KELLY 7018423000 709 4TH AVENUE NE WATFORD CITY ND 58854 DR RAVINDRA JOSHI PHYSICIAN 40.00 X 855010 0 14451 DANIEL KELLY CEO 40.00 10.00 X 567058 0 122047 MICHAEL CURTIS CAO 40.00 X 139345 0 18225 CHERYL FAULKNER CNO 40.00 X 115751 0 7106 SUSIE CURTIS CFO 40.00 X 111301 0 5599 PATSY LEVANG PRESIDENT 2.00 2.00 X X 0 0 0 MYRON HOVET VICE PRESIDENT 1.00 2.00 X X 0 0 0 JAN DODGE SECRETARY 1.00 2.00 X X 0 0 0 MICHON SAX SECRETARY (THRU NOVEMBER) 2.00 X X 0 0 0 JUSTIN VOLL TREASURER 1.00 X X 0 0 0 SCOTT SWENSON TREASURER (THRU NOVEMBER) 2.00 X X 0 0 0 GARY BROWN DIRECTOR 1.00 X 0 0 0 MONTY BULZOMI DIRECTOR 1.00 X 0 0 0 VIRGINIA CEYNAR DIRECTOR 1.00 X 0 0 0 TAMMY JAMES DIRECTOR 1.00 X 0 0 0 NEAL SHIPMAN DIRECTOR 1.00 X 0 0 0 1788465 0 167428 5 0 1 0 JE DUNN CONSTRUCTION TOTAL 800 WASHINGTON AVE N STE 600 MINNEAPOLIS MN 55401 CONSTRUCTION SERVICES 7010990 RURAL MEDICAL PARTNERS 4956 CURRAN COURT GRAND FORKS ND 58201 CONTRACT MEDICAL PROVIDERS 1406459 GUARDIAN HEALTHCARE PROVIDERS 105 WESTPARK DRIVE SUITE 100 BRENTWOOD TN 37027 CONTRACT NURSING STAFF 803573 ACUTE CARE INC 1609 N ANKENY BLVD SUITE 200 ANKENY IA 50023 CONTRACT MEDICAL PROVIDERS 732234 EQUALIZE RCM SERVICES PO BOX 679005 DALLAS TX 75267 MEDICAL BILLING SERVICES 622585 33 3673416 2965835 934490 7573741 HOSPITAL PATIENT SERVICE REVENUE 621400 21117686 21117686 NURSING HOME SERVICE REVENUE 621400 4546520 4546520 CLINIC SERVICE REVENUE 621400 3084973 3084973 WELLNESS CENTER 621400 587312 452060 135252 ASSISTED LIVING SERVICE REVENUE 621400 207995 207995 29544486 14792 14792 802877 1026721 -223844 -223844 -127647 -96197 5750 0 5750 5750 5750 340 B REVENUE 621400 624730 624730 CAFETERIA AND DIETARY REVENUE 900099 34464 34464 317979 317979 977173 37892098 29581904 324413 412040 X 1089189 1089189 12092462 10991794 1100668 261566 261566 1338511 966919 371592 870348 736536 133812 3660 3660 200547 200547 9023302 6697695 2325607 61907 3438 58469 234089 52815 181274 33932 738 33194 535765 535765 84431 22867 61564 38543 18951 19592 1371874 1277867 94007 6581404 6133060 448344 166835 71764 95071 BAD DEBT & COLLECTION 3318730 3318730 PROGRAM SUPPLIES 1853963 1803195 50768 EQUIPMENT RENTAL & MAIN 118934 39214 79720 DUES AND SUBSCRIPTIONS 75028 19106 55922 420741 41782 378959 39775761 32993802 6781959 0 35381 29287 1421268 5328523 10546776 9615263 4513060 5357453 238161 863621 133582 253937 112967859 25936750 91973184 87031109 200000 200000 6895907 9250514 115957319 117929707 4088040 3150879 0 4153892 420984 721601 74236211 72957845 117517 1734586 78862752 82718803 X 24590469 25486519 12504098 9724385 37094567 35210904 115957319 117929707 -1883663 0 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 1691 1691 0 PART II-B, LINE 1: THE ORGANIZATION IS A MEMBER OF NORTH DAKOTA HOSPITAL ASSOCIATION AND NORTH DAKOTA LONG TERM CARE ASSOCIATION. A PORTION OF MEMBERSHIP DUES TO THE ABOVE LISTED ASSOCIATIONS IS USED FOR LOBBYING. THESE ASSOCIATIONS ADVOCATE ON BEHALF OF ITS MEMBERS FOR IMPROVING EFFICIENCY AND ACCESSIBILITY OF THE HEALTHCARE DELIVERY SYSTEMS AND THE HEALTH STATUS OF NORTH DAKOTA'S POPULATION. 1144947 1144947 60436880 11503223 48933657 50587133 14433527 36153606 798899 798899 87031109 ASSETS RESTRICTED AS TO USE 8806419 CASH SURRENDER VALUE OF LIFE INSURANCE 444095 9250514 REFUNDABLE ADVANCES 1734586 1734586 1 1 X 1 X 175.000000000000 1 X 248.000000000000 1 1 1 0 0 234260 234260 0.00590 3257140 2889777 367363 0.00920 3491400 2889777 601623 0.01510 49317 49317 38930 38930 0.00100 7307978 6008369 1299609 0.03270 7396225 6057686 1338539 0.03370 10887625 8947463 1940162 0.04880 21970 21970 0.00060 21970 21970 0.00060 1 3136533 0 5194124 5221775 -27651 X 1 1 1 1 MCKENZIE COUNTY HEALTHCARE SYSTEMS INC 709 4TH AVE NE WATFORD CITY ND 58854 HTTP://MCKENZIEHEALTH.COM/ 5051A X X X X SWING BED UNIT, URGENT CARE, PT/OT MCKENZIE COUNTY HEALTHCARE SYSTEMS INC 1 0 0 1 X X X X X X X X X 18 1 0 0 1 X HTTPS://WWW.MCKENZIEHEALTH.COM/ABOUT/ X 1 18 1 HTTPS://WWW.MCKENZIEHEALTH.COM/ABOUT/ 0 1 X 175.000000000000 248.000000000000 X X X 1 1 X X X X 1 X SEE SUPPLEMENTAL INFORMATION X SEE SUPPLEMENTAL INFORMATION X HTTPS://WWW.MCKENZIEHEALTH.COM/ABOUT/BILLING/ X X X X X X X 1 X 0 X X X X 1 X 0 0 MCKENZIE COUNTY HEALTHCARE SYSTEMS INC PART V, SECTION B, LINE 5: APPROXIMATELY 350 PRINTED SURVEYS WERE DISTRIBUTED TO AREA RESIDENTS THROUGH VARIOUS CHANNELS THROUGHOUT THE COMMUNITY. 54 SURVEYS WERE RETURNED AND THE HOSPITAL IDENTIFIED SOME INFORMATION GAPS BASED ON THE DEMOGRAPHIC INFORMATION FROM THE SURVEYS RETURNED COMPARED TO TOTAL DEMOGRAPHIC INFORMATION. THEN INFORMATION INTERVIEWS WERE CONDUCTED. INTERVIEWS WERE 2 HOURS LONG AND CONDUCTED WITH 12 MEMBERS CHOSEN FROM THE COMMUNITY. INCLUDED AMONG THOSE INTERVIEWED WAS A PUBLIC HEALTH NURSE, PUBLIC SERVANTS, SCHOOL ADMINISTRATORS, THE COUNTY SHERIFF, BUSINESS PERSONS AND HEALTHCARE ADMINISTRATORS. MCKENZIE COUNTY HEALTHCARE SYSTEMS INC PART V, SECTION B, LINE 11: THE THREE MAIN AREAS OF CONCERN BROUGHT TO OUR ATTENTION DURING THE LAST CHNA REPORT IN 2019 HIGHLIGHTED: HOUSING, DOMESTIC ABUSE, AND HEALTHCARE STAFFING. MCHS CONTINUES TO ACTIVELY WORK WITH COMMUNITY AND CITY LEADERS ON HOUSING OPTIONS AND POTENTIAL PLANNING TO INCREASE THE AVAILABILITY OF SINGLE-FAMILY HOUSING IN OUR COUNTY. THIS INVOLVEMENT IS BOTH VERBAL AS WELL AS THROUGH ACTIVE INVOLVEMENT IN COMMITTEES, SURVEYS, AND MISC. ENGAGEMENTS ASKED OF US BY CIVIC LEADERSHIP. ON POSITIVE OUTCOME OF THESE EFFORTS IS THAT THE MCKENZIE COUNTY JOB DEVELOPMENT AUTHORITY HAS ENACTED A PROGRAM WHEREBY CITIZENS PURCHASING A NEW HOME CAN RECEIVE A $50,000 OFFSET.AS OF EARLY 2019 AND ESTIMATED TO BE COMPLETED BY THE BEGINNING OF 2020, MCHS IS DEVELOPING LASTING RELATIONSHIPS WITH LOCAL HEALTH RESOURCES, SPECIFICALLY THOSE ADDRESSING DOMESTIC ABUSE AND VIOLENCE IN THE HOME. BY FACILITATING THESE ARRANGEMENTS MCHS AND ITS PARTNERSHIPS HOPE TO INCREASE LOCAL ACCESS AND AWARENESS OF DOMESTIC VIOLENCE MATERIAL THROUGH REFERRAL SOURCES, ONLINE EDUCATION, AND EDUCATIONAL BROCHURES TO BE LOCATED THROUGHOUT OUR HEALTHCARE FACILITY WHILE SIMULTANEOUSLY OFFERING DISCREET PACKAGING OF SUCH MATERIAL AND A PROFOUND SUPPORT AMONGST STAFF TO OFFER RESOURCES TO THOSE IN NEED. LASTLY, MCHS CONTINUES TO PUSH TOWARDS ITS RECRUITMENT OF EMPLOYED STAFF, SPECIFICALLY NURSING STAFF. A GOAL OF THE CHNA REPORT WAS TO EMPLOY AT LEAST 25% OF OUR OWN NURSING STAFF TO LESSEN OUR NEED TO LEAN ON TEMPORARY OR LONG-TERM STAFFING ORGANIZATIONS. MCHS IS OFFERING AN ONSITE LICENSED PROFESSIONAL NURSE PROGRAM WITH A TWOFOLD PURPOSE. FIRST, WE WANT TO MAKE THIS OPPORTUNITY AVAILABLE TO AREA RESIDENTS. SECOND, IT IS THE DESIRE OF MCHS TO OFFER EMPLOYMENT TO GRADUATES OF THE PROGRAM. THE INTENT IS TO EXPAND THIS IN THE NEXT TWO YEARS TO OFFER TRAINING LEADING TO STUDENTS BECOMING REGISTERED NURSES. BY HIGHLIGHTING OUR EMPLOYMENT BENEFITS, ENRICHING OUR ORGANIZATIONAL CULTURE, STAYING COMPETITIVE, AND WORKING WITH THE COUNTY TO PROVIDE MORE HOUSING, WE ARE CONFIDENT THAT THE CONTINUED GROWTH OF MCHS WILL BE SUPPORTED BY OUR OWN, EMPLOYED, STAFF. MCKENZIE COUNTY HEALTHCARE SYSTEMS INC PART V, SECTION B, LINE 16J: IN ADDITION TO PROVIDING THE FULL POLICY UPON REQUEST, A SUMMARY OF THE POLICY IS POSTED IN THE EMERGENCY ROOMS, WAITING ROOMS, AND ADMISSIONS OFFICE. UPON ADMISSION THE PATIENTS RECEIVE A BROCHURE IN A PACKET REFERENCING THE FINANCIAL ASSISTANCE POLICY. THE PATIENTS ALSO RECEIVE INFORMATION IN THEIR FIRST BILLING INVOICE REGARDING THE FINANCIAL ASSISTANCE POLICY.FAP WEBSITE:HTTPS://WWW.MCKENZIEHEALTH.COM/ABOUT/BILLING/FAP APPLICATION WEBSITE:HTTPS://WWW.MCKENZIEHEALTH.COM/ABOUT/BILLING/FAP PLAIN LANGUAGE SUMMARY:HTTPS://WWW.MCKENZIEHEALTH.COM/ABOUT/BILLING/ 5 1 - GOOD SHEPHERD HOME 709 4TH AVE NE WATFORD CITY ND 58854 LT CARE & BASIC CARE 2 - MCKENZIE COUNTY CLINICS 709 4TH AVE NE WATFORD CITY ND 58854 RURAL HEALTH CLINIC 3 - MCKENZIE COUNTY URGENT CARE CLINIC 525 N MAIN ST WATFORD CITY ND 58854 URGENT CARE CLINIC 4 - CONNIE WOLD WELLNESS CENTER 200 8TH ST NE WATFORD CITY ND 58854 WELLNESS CENTER 5 - HORIZON ASSISTED LIVING 705 4TH AVE NE WATFORD CITY ND 58854 ASSISTED LIVING FACILITY PART I, LINE 7: THE ORGANIZATION UTILIZES THEIR COST REPORT TO DETERMINE THE COST-TO-CHARGE RATIO. THE COST REPORT IS BASED OFF OF THE INTERNAL REPORTING SYSTEM USED BY THE ORGANIZATION. PART I, LINE 7G: THE ORGANIZATION INCLUDED THE OPERATIONS OF THEIR SKILLED NURSING FACILITY AND RURAL HEALTH CLINIC IN THE SUBSIDIZED SERVICES CALCULATION. THE TOTAL COST AND OFFSETTING REVENUE FOR THE SKILLED NURSING FACILITY TOTALED $4,088,954 AND $3,355,291 RESPECTIVELY. THE TOTAL COST AND OFFSETTING REVENUE FOR THE RURAL HEALTH CLINIC TOTALED $3,219,024 AND $2,653,077 RESPECTIVELY. PART II, COMMUNITY BUILDING ACTIVITIES: OUR HOSPITAL PROVIDES CHARITY CARE AND OTHER COMMUNITY BENEFITS AS DEFINED BY THE IRS. BUT IN ADDITION, WE BELIEVE THAT WE PROVIDE A CRITICALLY IMPORTANT COMMUNITY BENEFIT WHICH IS NOT QUANTIFIED. OUR HOSPITAL, LIKE MOST RURAL HOSPITALS, WAS CREATED AND IS MAINTAINED IN ORDER TO PROVIDE LOCAL ACCESS TO MANY HEALTH SERVICES: BIRTHING CENTER, DIAGNOSTICS, EMERGENCY SERVICES AND URGENT CARE, HOME CARE, HOSPICE, INFUSION SERVICES, INPATIENT CARE, LABORATORY SERVICES, OCCUPATIONAL HEALTH, REHABILITATION SERVICES, SPECIALTY MEDICINE, SPEECH AND AUDIOLOGY, SURGICAL SERVICES, AND WOMEN'S HEALTH. PART III, LINE 2: THIS AMOUNT IS CALCULATED BY MULTIPLYING THE TOTAL CHARGES FOR SERVICES WRITTEN OFF AS BAD DEBT BY THE COST TO CHARGE RATIO. PART III, LINE 3: THE ORGANIZATION IS DILIGENT TO EVALUATE EACH PATIENTS ABILITY TO PAY AND DISTINGUISH BETWEEN BAD DEBT AND CHARITY CARE. PART III, LINE 4: PATIENT AND RESIDENT ACCOUNTS RECEIVABLE ARE RECORDED IN THE ACCOMPANYING CONSOLIDATED BALANCE SHEETS NET OF CONTRACTUAL ADJUSTMENTS AND AN ALLOWANCE FOR DOUBTFUL ACCOUNTS, WHICH REFLECT MANAGEMENT'S BEST ESTIMATE OF THE AMOUNTS THAT WILL NOT BE COLLECTED. MANAGEMENT PROVIDES FOR CONTRACTUAL ADJUSTMENTS UNDER TERMS OF THIRD-PARTY REIMBURSEMENT AGREEMENTS THROUGH A REDUCTION OF GROSS REVENUE AND A CREDIT TO PATIENT AND RESIDENT ACCOUNTS RECEIVABLE. IN ADDITION, MANAGEMENT PROVIDES FOR PROBABLE UNCOLLECTIBLE AMOUNTS, PRIMARILY FOR UNINSURED PATIENTS AND AMOUNTS PATIENTS AND RESIDENTS ARE PERSONALLY RESPONSIBLE FOR, THROUGH A REDUCTION OF GROSS REVENUE AND A CREDIT TO THE ALLOWANCE FOR DOUBTFUL ACCOUNTS. IN EVALUATING THE COLLECTABILITY OF PATIENT AND RESIDENT ACCOUNTS RECEIVABLE, THE HEALTH SYSTEMS ANALYZES PAST RESULTS AND IDENTIFIES TRENDS FOR EACH OF ITS MAJOR PAYER SOURCES OF REVENUE TO ESTIMATE THE APPROPRIATE ALLOWANCE FOR DOUBTFUL ACCOUNTS AND PROVISION FOR BAD DEBTS. MANAGEMENT REGULARLY REVIEWS DATA ABOUT THESE MAJOR PAYER SOURCES OF REVENUE IN EVALUATING THE SUFFICIENCY OF THE ALLOWANCE FOR DOUBTFUL ACCOUNTS. PART III, LINE 9B: THE ORGANIZATION DOES NOT COLLECT ON ACCOUNTS THAT HAVE A FINANCIAL ASSISTANCE APPLICATION IN REVIEW OR THAT HAS BEEN APPROVED. IF THE ACCOUNT IS NOT COMPLETELY WRITTEN OFF (BASED ON THE SLIDING FEE SCHEDULE) AND THEY DO NOT FOLLOW THROUGH ON THEIR PAYMENT PLAN FOR THE BALANCE, THAT WOULD BE THE ONLY TIME THE ACCOUNT WAS OUTSOURCED TO COLLECTIONS. PART VI, LINE 2: SEPARATE EVALUATIONS ARE COMPLETED ANNUALLY FOR THE CRITICAL ACCESS HOSPITAL AND THE RURAL HEALTH CLINIC. AT THIS TIME SERVICES AND STATISTICS ARE REVIEWED. EACH REPORT IS PRESENTED TO THE MEDICAL STAFF MEMBERS AND BOARD OF DIRECTORS. CURRENT SERVICES ARE DISCUSSED ALONG WITH THE NEEDS NOT CURRENTLY BEING MET. MANAGERS OF EACH DEPARTMENT ANNUALLY REVIEW THEIR SERVICES WITH THE BUDGETING PROCESS AND DISCUSS POSSIBLE PROJECTION OF NEW SERVICES. ONCE A NEED IS DETERMINED, IT IS DISCUSSED ON A DEPARTMENTAL LEVEL, INFORMATION IS GATHERED AND PRESENTED TO THE CEO/CFO FOR APPROVAL. MCHS HOLDS THEIR ANNUAL MEETING FOR THE PUBLIC IN THE FALL OF EACH CALENDAR YEAR. THIS IS AN OPEN MEETING ALLOWING THE PUBLIC TO VOICE CONCERNS AND SUGGESTIONS. PART VI, LINE 3: THE MCHS CHARITY CARE POLICY IS POSTED IN THE HOSPITAL AND CLINIC ADMISSIONS AREAS AND EMERGENCY ROOM. COPIES OF THE POLICY AND APPLICATIONS ARE AVAILABLE IN EACH RECEPTION AREA OF THE HOSPITAL AND CLINIC. INFORMATION IS SENT OUT TO ALL PATIENTS WITH THEIR FIRST STATEMENT. IF A BILL IS UNPAID, AFTER TWO STATEMENTS HAVE BEEN SENT, A BILLING EMPLOYEE WILL ATTEMPT TO REACH THE RESPONSIBLE PARTY BY PHONE TO DISCUSS INSTALLMENT PLANS, CHARITY CARE, AND/OR DISCUSS VARIOUS GOVERNMENT BENEFITS SUCH AS MEDICAID. THE MCHS BUSINESS OFFICES ALSO HAVE THE APPLICATIONS AT ALL TIMES. THE BUSINESS OFFICE STAFF COUNSEL ANYONE WHO PRESENTS THEMSELVES WITH OVERDUE BALANCES AND PRESENT THE ABOVE OPTIONS. PART VI, LINE 4: MCKENZIE COUNTY HEALTHCARE SERVICES SERVES MCKENZIE COUNTY. MCKENZIE COUNTY IS THE LARGEST COUNTY IN THE STATE OF NORTH DAKOTA. IT IS VERY RURAL AND INCLUDES PART OF THE FORT BERTHOLD RESERVATION. MCKENZIE COUNTY HOSPITAL IS THE ONLY HEALTHCARE SYSTEM WITHIN A 45 MILE RADIUS. THE COUNTY'S POPULATION WAS ESTIMATED IN 2010 AT 6,380. THE MEDIAN HOUSEHOLD INCOME IN 2010 WAS REPORTED AT $48,480. 100% OF THE POPULATION WAS REPORTED BELOW THE POVERTY LEVEL IN 2010. THE RUGGED TERRAIN, WINTER CONDITIONS, INCREASED OIL ACTIVITY, AND RECREATIONAL ACTIVITIES HAVE ALL ADDED TO THE INCREASED NUMBER OF EMERGENCY ROOM VISITS. WITH THE RECENT OIL ACTIVITY IN THE STATE, MCKENZIE COUNTY IS EXPERIENCING A RAPID INCREASE IN POPULATION, NEW BUSINESSES, HOUSING PROJECTS, AND IMPROVED WAGE SCALES. WITH THIS RAPID GROWTH, MCHS IS EXPERIENCING AN INFLUX IN EMERGENCY ROOM SERVICES, SHORTAGE OF PHYSICIANS AND NURSES, AS WELL AS GROWING BAD DEBT EXPENSES RELATED TO MEDICAL SERVICES PROVIDED TO UNINSURED WORKERS AND PATIENTS THAT DO NOT HAVE A PERMANENT RESIDENCE TO SEND BILLS TO. PART VI, LINE 5: THE MCKENZIE COUNTY BOARD OF DIRECTORS IS MADE UP OF VOLUNTEER MEMBERS FROM THE LOCAL COMMUNITY OF WATFORD CITY AND THE SURROUNDING AREAS. MCHS DOES EXTEND PRIVILEGES TO ALL PHYSICIANS IN THE AREA. SPECIALISTS WILL ALSO VISIT THE LOCAL HOSPITAL AND CLINIC TO EXPAND THE PRESENT SERVICES. SURPLUS FUNDS ARE APPLIED FOR THE PURPOSES EDUCATION, INCREASING PATIENT SERVICES, WELLNESS, AND PREVENTATIVE CARE TO ITS CLIENTS. MCHS IS ALSO A PART OF A WORKSITE WELLNESS NORTH DAKOTA PROGRAM. IT ALLOWS THEIR CARDIAC WELLNESS MANAGER (RN) TO WORK CLOSELY IN THE STATE-WIDE PROGRAM THAT CAN GREATLY IMPROVE THE HEALTH OF EMPLOYEES, RESULTING IN LOWER HEALTH CARE COSTS, AND INCREASED PRODUCTIVITY AND MORALE. MCKENZIE COUNTY HEALTHCARE SYSTEMS AND THE MCKENZIE COUNTY HEALTHCARE SYSTEMS BENEFIT FUND TOGETHER ENGAGED IN THE BUILDING AND FUNDING OF A NEW WELLNESS CENTER. THE WELLNESS CENTER OPENED IN MARCH 2013. THE WELLNESS CENTER HOUSES A NEW PHYSICAL THERAPY DEPARTMENT TO BETTER UTILIZE A THERAPY POOL AND HAS INCREASED THE PRESENT SQUARE FOOTAGE OF THE HOSPITAL. PREVENTION IS A KEY WORD TODAY. THE WELLNESS CENTER PROVIDES EDUCATION AND EXERCISE TO ITS MEMBERS. IT WILL HELP IMPROVE OR PREVENT DISEASES LIKE DIABETES, HIGH BLOOD PRESSURE, OBESITY, DEPRESSION, AND MANY NOT LISTED. IN AN EFFORT TO ENHANCE SERVICES IN THE RURAL AREAS, MCKENZIE COUNTY HEALTHCARE PARTICIPATES IN SEVERAL PROGRAMS. THE RURAL ACCOUNTABLE CARE ORGANIZATION IS INTENDED TO BETTER SERVE OUR POPULATION BY IMPROVING HEALTHCARE, PATIENT SATISFACTION, AND REDUCING COSTS WHILE IMPROVING FINANCIAL PERFORMANCE AND SUSTAINABILITY. THE FRONTIER COMMUNITY HEALTHCARE INTEGRATION PROJECT (FCHIP) IS A DEMONSTRATION PROGRAM THAT ASSISTS OUR ORGANIZATION WITH PROVIDING TELEMEDICINE SERVICES TO OUR POPULATION IN ORDER TO PROVIDE ACCESS TO MORE SPECIALTY SERVICES TO THE RESIDENTS OF OUR COMMUNITIES. THESE PROGRAMS ARE AIMED AT INCREASING THE INTEGRATION AND COORDINATION OF CARE AMONGST PROVIDERS AND IMPROVE THE OVERALL QUALITY OF CARE FOR OUR HEALTHCARE COMMUNITY. PART VI, LINE 6: MCHS IS AN AFFILIATE OF SANFORD HEALTHCARE WHICH ASSISTS THE HEALTHCARE SYSTEM WITH SOFTWARE AND INTEGRATED EQUIPMENT, ULTIMATELY STREAMLINING HEALTHCARE ACROSS MULTIPLE STATES WHO USE THE SAME E.H.R. AND OTHER SANFORD RESOURCES. PART VI, LINE 7: N/A X X X 0 1 0 0 0 0 0 0 0 DR RAVINDRA JOSHI PHYSICIAN 804625 0 50385 0 0 0 11585 0 2866 0 869461 0 0 0 DANIEL KELLY CEO 277019 0 290039 0 0 0 120797 0 1250 0 689105 0 0 0 MICHAEL CURTIS CAO 125393 0 13818 0 134 0 7422 0 10803 0 157570 0 0 0 PART I, LINE 4B $92,500 WAS CONTRIBUTED TO A 457(F) PLAN FOR DANIEL KELLY. DANIEL KELLY CEO SPLIT DOLLAR LIFE INSURANCE POLICY X 92500 721601 0 1 1 721601 LESLIE KELLY SPOUSE OF CEO 57010 EMPLOYEE SALARY 0 SAMUEL KELLY SON OF CEO 77607 EMPLOYEE SALARY 0 FORM 990, PART III, LINE 2 RHC AND SPECIALTY CLINIC TELEHEALTH SERVICES DUE TO COVID. FORM 990, PART III, LINE 3 GIVEN COVID MONTHS PEAKED DURING FY2020, SEVERAL SERVICE LINES WERE CLOSED OR SIGNIFICANTLY REDUCED ESPECIALLY DURING THE HEIGHT OF THE CORONA VIRUS. SURGERY AND ANY ELECTIVE SERVICES WERE RESCHEDULED, CANCELLED, OR CLOSED DURING THE YEAR FOR SEVERAL WEEKS AT A TIME. FORM 990, PART VI, SECTION A, LINE 2 MICHAEL CURTIS AND SUSIE CURTIS HAVE A FAMILY RELATIONSHIP. FORM 990, PART VI, SECTION B, LINE 11B THE MCHS CEO AND CFO REVIEW AND APPROVE THE FORM 990. THE BOARD OF DIRECTORS RECEIVE A COPY OF THE FINAL FORM 990 BEFORE IT IS FILED WITH THE IRS. FORM 990, PART VI, SECTION B, LINE 12C AN INTERESTED PERSON IS DEFINED AS ANY DIRECTOR, PRINCIPAL OFFICER, AND ANYONE WHO HAS A DIRECT OR INDIRECT FINANCIAL INTEREST WITH RESPECT TO ALL ENTITIES IN THE HEALTHCARE SYSTEM. AN INTERESTED PERSON MUST DISCLOSE THE EXISTENCE OF THE FINANCIAL INTEREST AND WILL BE GIVEN THE OPPORTUNITY TO DISCLOSE ALL MATERIAL FACTS TO THE DIRECTORS. THE CONFLICT WILL BE REVIEWED BY THE REMAINING BOARD AND WILL DETERMINE IF A CONFLICT EXISTS. IF A CONFLICT EXISTS, THE INTERESTED PERSON MUST ABSTAIN FROM VOTING ON THE ISSUE AND THE REMAINING BOARD MEMBERS WILL DETERMINE IF THE TRANSACTION IS IN THE HOSPITAL'S BEST INTEREST, FOR ITS OWN BENEFIT, AND IF IT IS FAIR AND REASONABLE. THIS IS ACCOMPLISHED THROUGH ANNUAL REVIEW AND A SIGNED STATEMENT STATING THAT THE INTERESTED PERSON HAS OBTAINED A COPY OF THE POLICY AND HAS READ AND UNDERSTANDS THE POLICY, AND HAS AGREED TO COMPLY WITH THE POLICY. FORM 990, PART VI, SECTION B, LINE 15 MEMBERS OF THE BOARD OF TRUSTEES REVIEW STATE-WIDE SALARY SURVEY INFORMATION AND OTHER FORM 990'S WHEN DETERMINING ANY WAGE CHANGES. THE CEO HAS AN ANNUAL EVALUATION COMPLETED EACH YEAR. THE CEO HAS THE OPPORTUNITY TO GIVE A PROPOSAL TO THE BOARD AT HIS EVALUATION. ANY CHANGE OR REVISION IS RECORDED IN THE BOARD MINUTES. AN ADDENDUM TO THE TERMS OF EMPLOYMENT IS SIGNED BY THE BOARD PRESIDENT AND CEO FOR THE PERSONNEL FILE. THE CEO APPROVES THE CFO COMPENSATION BASED UPON SURVEY DATA ON AN ANNUAL BASIS. THE RESULTS ARE DOCUMENTED IN THE CFO'S ANNUAL EVALUATION PAPERWORK. FORM 990, PART VI, SECTION C, LINE 19 THE GOVERNING DOCUMENTS, CONFLICT POLICY, AND FINANCIAL STATEMENTS ARE AVAILABLE UPON REQUEST. FORM 990, PART IX, LINE 11G EMERGENCY ROOM PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 1,707,385. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,707,385. CLINIC MD PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 590,870. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 590,870. NURSING HOME PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 63,787. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 63,787. OTHER CONTRACTOR SERVICES: PROGRAM SERVICE EXPENSES 3,128,814. MANAGEMENT AND GENERAL EXPENSES 2,325,607. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 5,454,421. ADULTS AND PEDS SERVICES: PROGRAM SERVICE EXPENSES 1,206,839. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,206,839. MCKENZIE COUNTY HEALTHCARE SYSTEMS PROPERTIES 709 4TH AVE NE WATFORD CITY ND 58854 462905447 PROPERTY MANAGEMENT ND 36069 648475 MCKENZIE COUNTY HEALTHCARE SYSTEMS INC THE BENEFIT FUND OF MCKENZIE COUNTY HEALTHCARE SYSTEMS INC 709 4TH AVE NE WATFORD CITY ND 58854 363431210 TO SUPPORT THE MCKENZIE COUNTY HEALTHCARE SYSTEMS ND 501(C)(3) LINE 7 MCKENZIE COUNTY HEALTHCARE SYSTEMS INC 1 0 0 1 0 0 0 0 0 0 0 0 0 1 1 1 0 1 0 0 THE BENEFIT FUND OF MCKENZIE COUNTY HEALTHCARE SYSTEMS INC C 3673416 ACTUAL