2024-05-15T14:08:12-05:00 2023-06-30 450250958 Eide Bailly LLP 1730 Burnt Boat Loop Ste 100 Bismarck ND 585030886 990 2022-07-01 770637498 McKenzie County Healthcare Systems Inc MCKE 7018423000 709 4th Avenue NE Watford City ND 58854 Peter Edis CEO 7018423000 2024-05-15 1 Peter Edis 999009999 1 Lisa Chaffee CPA P00193453 7012551091 2024-05-07 2 AAL1 IAL1 2022 2023-04-26 12:10:37Z Peter Edis 709 4th Avenue NE Watford City ND 58854 56238015 0 X www.mckenziehealth.com X 2004 ND Health care service provider. 9 9 323 10 419120 0 4576103 11743198 37708352 43954736 -34891 -267163 -434822 -559823 41814742 54870948 0 0 0 0 19164181 21966744 0 0 0 25820880 28668869 44985061 50635613 -3170319 4235335 103424427 105701816 72370875 70906408 31053552 34795408 X Mckenzie County Healthcare Systems is a faith-based organization dedicated to professional, compassionate and quality healthcare. 1 0 30081985 31591689 McKenzie County Healthcare Systems provides 24 hour x 7 days a week services. MCHS provided in-patient, observation, and swing bed services and obstetrics - hospital - total inpatient/observation days -1,053. Total swing bed days -730. MCHS offers various other services. They offer endoscopic exams. Total Outpatient Surgeries - 739. The emergency room is open 24 hours a day, 7 days a week. Total Emergency Room visits - 5,345. 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 - 1,396. Total outpatient procedures 28,795 Total births - 25. 3250675 5709620 The McKenzie County Healthcare System (MCHS) Good Shepherd Home (GSH) is a 47 bed skilled nursing home with an attached 9-bed basic care unit. 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 90.2%. 7498392 6226714 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 8am to 8pm 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. 339052 426713 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 98.3% 339052 426713 41170104 1 1 0 1 0 0 0 0 1 0 1 0 0 0 1 1 0 1 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 1 1 1 0 0 1 89 0 1 323 1 1 1 0 0 0 0 0 0 0 0 0 0 0 X 9 9 0 1 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 0 0 X Peter Edis 7018423000 709 4th Avenue NE Watford City ND 58854 Gary Brown Chair 1.00 1.00 X X 0 0 0 Justin Voll Vice-chair 1.00 0.00 X X 0 0 0 Randy Quale Treasurer 1.00 1.00 X X 0 0 0 Jan Dodge Secretary 1.00 1.00 X X 0 0 0 Monty Bulzomi Director 1.00 0.00 X 0 0 0 Virginia Ceynar Director 1.00 0.00 X 0 0 0 Tammy James Director 1.00 0.00 X 0 0 0 Yolanda Rojas Director (Jan-Jun) 1.00 0.00 X 0 0 0 Chase Wisness Director 1.00 0.00 X 0 0 0 Neal Shipman Vice Chair (Jul-Dec) 1.00 0.00 X X 0 0 0 Peter Edis CEO 40.00 0.00 X 251040 0 34137 Cheryl Batchelor Interim CFO 38.00 2.00 X 0 0 0 Robert Black Interim COO (July thru May) 40.00 0.00 X 126000 0 0 Theo Stoller COO (as of April) 40.00 0.00 X 0 0 0 Cheryl Faulkner CNO 40.00 0.00 X 127987 0 29539 Dr Gary Ramage Medical Director, Physicia 32.00 0.00 X 351575 0 46428 Dr Ravindra Joshi Orthopedic Surgeon 40.00 0.00 X 856783 0 21616 Dr Craig Smith Anesthesiologist 40.00 0.00 X 361234 0 14336 Dr Maria Marchenko Pediatrician 40.00 0.00 X 274220 0 37514 Dr Vincent Adjetey Pediatrician 40.00 0.00 X 265342 0 26285 Dr Lucinda Mundorf Internal Medicine 40.00 0.00 X 258553 0 25531 Daniel Kelly Former President 10.00 10.00 X 254130 0 26554 3126864 0 261940 34 1 1 0 Acute Care Inc 1609 N Ankeny Blvd Ankeny IA 50023 Contract Physicials 2307902 American Consultants 9359 W 75th St Overland Park KS 66204 Contract Workers 1984715 Equalize RCM Services PO Box 679005 Dallas TX 75267 Accounts Receivable Management 1463371 Epic International Staffing PO Box 306098 Nashville TN 37230 Contract Workers 1330726 Sanford Health Lawson Building 5074 Sioux Falls SD 57117 Health Services 1054637 21 1311551 10300000 131647 11743198 Hospital Patient Service Revenue 621110 27420301 27420301 Clinic Service Revenue 621110 6226714 6226714 Nursing Home Service Revenue 623000 5709620 5709620 340B Pharmacy Revenue 456110 2889283 2889283 Assisted Living Rental 623000 426713 426713 1282105 841222 440883 43954736 19288 19288 520793 1080616 -559823 -559823 -21763 -538060 286451 -286451 -286451 -286451 54870948 43513853 419120 -805223 X 974581 306549 668032 278983 278983 16765082 15070126 1694956 533518 504127 29391 2231734 1715933 515801 1182846 1006878 175968 49688 49688 14811 14811 12849590 10126110 2723480 216391 61734 154657 744688 570267 174421 584934 584934 682725 607032 75693 205800 191764 14036 159667 104364 55303 1428417 1198709 229708 6566393 5521766 1044627 361835 138891 222944 Medical Supplies 2083626 2110336 -26710 Pharmaceuticals 912312 912312 Repairs and Maintenance 554446 389849 164597 Food Service Supplies 440500 435481 5019 813046 197876 615170 50635613 41170104 9465509 0 3567178 4807834 6695536 5324223 6470547 7655818 1017730 1037389 318722 618785 113747438 42542037 75999026 71205401 9284832 14693173 70856 359193 103424427 105701816 3349923 3621798 60813 74070 68925139 67190540 35000 20000 72370875 70906408 X 31053552 34795408 31053552 34795408 103424427 105701816 X 4235335 110285 -603764 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 1490 1490 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. 0 1 X 1144947 1144947 58081049 18135196 39945853 48820013 22405725 26414288 5701429 2001116 3700313 71205401 Postretirement Benefit Obligation 20000 20000 X 56061849 110285 110285 55951564 -1080616 -1080616 54870948 51716229 1080616 1080616 50635613 0 50635613 Part IV, Line 2b: The Organizations holds security deposits, as well as resident trust funds. Part X, Line 2: The Health System believes it has 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 Health System would recognize future accrued interest and penalties related to unrecognized tax liabilities in income tax expense if such interest and penalties are incurred. Part XI, Line 4b - Other Adjustments: Rental Expenses Included in Expenses on Financials -1,080,616. Part XII, Line 2d - Other Adjustments: Rental Expenses Included in Revenue on Form 990 1,080,616. 1 1 X 1 X 1 X 1 1 1 0 0 147000 147000 0.00290 4795954 4269874 526080 0.01040 4942954 4269874 673080 0.01330 14846140 3999333 10846807 0.21420 14846140 3999333 10846807 0.21420 19789094 8269207 11519887 0.22750 1 3667594 275070 9112423 9178362 -65939 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 21 1 0 0 1 X https://mckenziehealth.com/chna/ X 1 21 1 https://mckenziehealth.com/chna/ 0 1 X 100.000000000000 250.000000000000 X X X 1 1 X X X X 1 X https://mckenziehealth.com/patient-services/billing/ X https://mckenziehealth.com/patient-services/billing/ X https://mckenziehealth.com/patient-services/billing/ 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: Residents of the area were given the opportunity to participate in a survey. One hundred twenty-nine MCHS service area residents completed the survey. Additional information was collected through seven key informant interviews with community members. The input from the residents, who primarily reside in McKenzie County, represented the broad interests of the communities in the service area. Together with secondary data gathered from a wide range of sources, the survey presents a snapshot of the health needs and concerns in the community. A steering committee was responsible for planning and implementing the process. The committee consisted of the McKenzie County Courthouse Job Development Authority, a local bank Public Relations representative, the Chief of Ambulance at McKenzie County Ambulance, the Interim Director of Operations at MCHA, and the school Superintendent. McKenzie County Healthcare Systems Inc. Part V, Section B, Line 11: The most recent CHNA conducted in fiscal year 2022 identified the following significant needs:1. Not enough Affordable Housing2. Availability of resources to help the elderly remain at home. 3. Having enough child daycare services. 4. Availability of mental health ServicesThe organization will not be addressing affordable housing due to limited financial and other resources. Affordable housing is being addressed in collaboration with the City of Watford City and County through creation of a Housing Board, a subset of the Job Development Authority (JDA). The Housing Board is actively working with the City to build six or seven affordable single-family homes through a rent, save, purchase program. Additionally, the JDA created a builder's incentive program and two houses are being built. Actions taken in prior years to address the fiscal year 2022 CHNA needs that continued in the current tax year:1. McKenzie Health provides a home and community-based service as well as remote patient monitoring to help the elderly, disabled, and medically frail remain in their homes. 2. McKenzie Health enrolled in the state childcare employer partnership program and provides $300, which the state matches to employees to help pay for childcare. Additionally, McKenzie Health secured childcare spaces at the local child daycare center exclusively for McKenzie Health employees. 3. McKenzie Health entered into contract with a tele-psychiatric provider to provide behavioral health / psychiatric assessment, diagnosis, and medication. McKenzie Health met with a local counseling provider and has an agreement to refer patients that need ongoing therapy. 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. 5 1 - Good Shepherd Home 709 4th Ave NE Watford City ND 58854 LT Care and 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: Charity care for Part I, line 7a was converted to cost by multiplying the ratio of cost to gross charges by the gross uncompensated charges associated with providing charity care to its patients.The costs for Medicaid in Part I, line 7b and Subsidized Health Services in Part I, line 7g were determined based on costs allocated to the relevant cost centers on the Medicare Cost Report. Part I, Line 7g: Subsidized health services includes costs of $3,617,049 from a provider based clinic, and $4,978,127 from a rural health clinic. Part III, Line 2: The amount reported on line 2 represents implicit price concessions. The Hospital determines its estimate of implicit price concessions based on its historical collection experience with this class of patients. Part III, Line 3: The organization calculated Line 3 by multiplying the implicit price concessions by the percent of the population in the community that is below the Federal Poverty Guidelines. The percent of the population in the community that is below the Federal Poverty Guidelines is 7.5%. Part III, Line 4: The footnote to the Organization's financial statements can be found on pages 13 and 14 of the attached audited financial statements. Part III, Line 8: Medicare allowable costs of care are 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. Part III, Line 9b: The Organization does not collect on accounts that, at any point, have a financial assistance application in review or that has been approved. This is the practice even if the patient applies after the 240 days period after the date of the first invoice for the service. 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. Self pay patients are identified at the point of registration and receive a 35% write off.The Organization provides a copy of the plain language summary of the financial assistance policy with all billing statements and communications that occur within the first 120 days following the first billing statement. 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, and 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 McKenzie County Healthcare Systems, Inc. County's population was estimated in 2021 at 13,819. The median household income in 2021 was reported at $75,238. 7.5% of the population was reported below the poverty level in 2021. 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 in the last decade, McKenzie County is experiencing an 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 wellness center. The wellness center opened in March 2013. The wellness center houses a 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 helps 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.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 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. X X 0 0 0 0 0 0 0 0 0 Dr Ravindra Joshi Orthopedic Surgeon 829879 0 0 0 26904 0 7955 0 13660 0 878398 0 0 0 Dr Gary Ramage Medical Director, Physicia 336606 0 1500 0 13469 0 18300 0 28128 0 398003 0 0 0 Dr Craig Smith Anesthesiologist 360251 0 0 0 983 0 13982 0 354 0 375570 0 0 0 Dr Maria Marchenko Pediatrician 270731 0 0 0 3489 0 16838 0 20676 0 311734 0 0 0 Dr Vincent Adjetey Pediatrician 262299 0 0 0 3043 0 16052 0 10233 0 291627 0 0 0 Peter Edis CEO 238540 0 12500 0 0 0 13461 0 20676 0 285177 0 0 0 Dr Lucinda Mundorf Internal Medicine 253453 0 0 0 5100 0 15655 0 9876 0 284084 0 0 0 Daniel Kelly Former President 229014 0 24465 0 651 0 15468 0 11086 0 280684 0 0 0 Cheryl Faulkner CNO 127107 0 400 0 480 0 8117 0 21422 0 157526 0 0 0 Leslie Kelly Spouse of Former Officer 44227 Employee salary 0 Samuel Kelly Son of Former CEO 30888 Employee salary 0 Form 990, Part III, line 2 McKenzie County Helathcare Systems started offering obstetrics services. Form 990, Part VI, Section A, line 3 The Interim CFO, Cheryl Batchellor, is paid by an unrelated management company, American Consultants, for her services to both the Benefit Fund of McKenzie County Healthcare Systems and McKenzie County Healthcare Systems (MCHS). In calendar year 2022, MCHS paid $317,200 for her services. Form 990, Part VI, Section B, line 11b The MCHS CEO and CFO review and approve the Form 990. The Board of Directors recieve 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 15a Members of the Board of Trustees review state-wide salary survey information and other Form 990s when determining any wage changes. The CEO has an annual evaluation completed. The CEO has the opportunity to give a proposal to the Board at their 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 other officer compensation based upon survey data on an annual basis. The results are documented in the officer'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 Service Contracts: Program service expenses 816,963. Management and general expenses 204,349. Fundraising expenses 0. Total expenses 1,021,312. Staffing Purchased Services: Program service expenses 3,889,651. Management and general expenses 621,237. Fundraising expenses 0. Total expenses 4,510,888. Consulting Services: Program service expenses 51,939. Management and general expenses 85,720. Fundraising expenses 0. Total expenses 137,659. Contracted Physician and Medical: Program service expenses 4,286,560. Management and general expenses 0. Fundraising expenses 0. Total expenses 4,286,560. Other Purchased Services: Program service expenses 1,049,582. Management and general expenses 1,348,833. Fundraising expenses 0. Total expenses 2,398,415. Collection Agency: Program service expenses 0. Management and general expenses 277,094. Fundraising expenses 0. Total expenses 277,094. Credit Card Fees: Program service expenses 6,929. Management and general expenses 152,435. Fundraising expenses 0. Total expenses 159,364. Software Maintenance Fees: Program service expenses 24,486. Management and general expenses 33,812. Fundraising expenses 0. Total expenses 58,298. Form 990, Part XI, line 9: Prior Period Restated Depreciation on Audited Financials -603,764. Form 990, Part XI, Line 9, Other Changes in Net Assets During 2023, the Health System discovered that June 30, 2022 accumulated depreciation and depreciation expense were understated by $603,764. Accordingly, this error was corrected impacting accumulated depreciation, depreciation expense, and net assets. Benefit Fund of McKenzie County Healthcare Systems 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 McKenzie County Healthcare Systems Properties 709 4th Ave NE Watford City ND 58854 462905447 Property Management ND McKenzie County Healthcare Systems Inc C 21650 669697 1.00000 1 0 0 1 0 0 0 0 0 0 0 0 0 1 1 1 0 1 0 0 Benefit Fund of McKenzie County Healthcare Systems C 1311551 Accrual