2022-03-30T13:40:22-05:00 2021-06-30 450250958 Eide Bailly LLP 1730 Burnt Boat Loop Ste 100 Bismarck ND 585030886 990 2020-07-01 450255914 Ashley Medical Center ASHL 7012883433 PO Box 450 612 Center Ave N Ashley ND 584130450 Eric Heupel Administrator 7012883433 2022-03-22 1 Eric Heupel 999009999 Lisa Chaffee CPA P00193453 7012551091 2022-03-22 2 AAL1 IAL1 2020 2022-09-23 18:48:47Z Jerry Lepp PO Box 450 612 Center Ave N Ashley ND 584130450 11410488 0 X amctoday.org X 1952 ND To construct, maintain, and operate health care facilities in the community of Ashley, ND. 9 8 155 20 0 0 210102 3564396 8158981 7830625 -5769 9587 362566 5880 8725880 11410488 0 0 0 0 5789907 5814572 0 0 0 3188944 2776927 8978851 8591499 -252971 2818989 7431535 8455161 5935977 4092498 1495558 4362663 X Ashley Medical Center is a community organization which provides preventative, curative, supportive and educational health care that meets the physical, emotional, and spiritual needs of the people we serve. 0 0 4432876 4673085 Acute health care consisting of Inpatient days of 152, Outpatient hours of 1,238, and swing bed days of 424. 1592049 2075179 Long term skilled care for the frail and elderly total resident days of 7,291. 1285078 818749 Rural Health Clinic Services with 2,846 clinic visits. 104662 263612 Other program services include apartment space to the elderly and low income under business code 721310. 104662 263612 7414665 1 1 0 0 0 0 0 0 1 0 1 0 0 1 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 18 0 1 155 1 0 0 0 0 0 0 0 0 0 0 0 0 X 9 8 0 0 0 0 1 1 0 1 1 0 0 1 1 1 1 1 1 1 1 0 X Jerry Lepp CFO 7012883433 612 Center Ave N Ashley ND 584130450 Polly Wyrick Ulrich President 1.00 X X 0 0 0 Kristie Schnabel Vice President 1.00 X X 0 0 0 Candace Nies Secretary 1.00 X X 0 0 0 Brenda Meyer Board Member 0.50 X 0 0 0 Anthony Neu Board Member 0.50 X 0 0 0 Michael Schlepp Board Member 0.50 X 0 0 0 JoAnne Stugelmayer Board Member 0.50 X 0 0 0 Sherrece Golz Board Member 0.50 X 0 0 0 Megan Thomas Board Member (Oct-Jun) 0.50 X 0 0 0 Mark Schaunaman Board Member (Jul-Oct) 0.50 X 0 0 0 Jerry Lepp CFO 32.00 X 69983 0 27588 Eric Heupel Administrator 40.00 X 110597 0 17715 Tara Brandner Nurse Practitioner 40.00 X 143948 0 34931 Lori Bichler Nurse Practitioner 40.00 X 188303 0 27211 Jeremy StAubin Physical Therapist 40.00 X 111138 0 30525 623969 0 137970 4 0 1 0 Dakota Travel Nurse Inc 3015 Memorial Hwy Mandan ND 58554 Temp Nursing 252746 Sanford Health PO Box 2010 Fargo ND 58122 Medical Director 100876 2 3464703 99693 3564396 Net Patient Revenue 623000 7652169 7652169 178456 178456 7830625 5880 0 5880 5880 5880 9587 0 9587 9587 9587 11410488 7830625 0 15467 231931 231931 131086 19621 111465 4305113 4163525 141588 116290 94221 22069 699908 554329 145579 330244 248986 81258 47523 47523 705349 626499 78850 32104 22090 10014 139077 104281 34796 197668 190161 7507 20273 12915 7358 70118 64324 5794 10619 9897 722 370653 345460 25193 74445 4505 69940 Medical Supplies 657929 651453 6476 Maintenance and Repairs 306967 187852 119115 Equipment Rentals 81387 81387 Rentals 7627 7627 55188 33159 22029 8591499 7414665 1176834 0 224 224 4677286 4910254 886983 906100 115395 153759 49298 82486 8741035 7032877 1288677 1708158 183672 222501 230000 471679 7431535 8455161 742196 771440 3603860 1786341 11591 11054 476430 376441 1101900 1092367 0 54855 5935977 4092498 X 1440403 4307508 55155 55155 1495558 4362663 7431535 8455161 2818989 48116 0 X 0 1 X 0 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 1 X 25001 25001 77390 5444459 4623714 898135 3194185 2409163 785022 1708158 Estimated Third Party Payor Settlem 471679 471679 Capital Lease 54855 54855 X 11458604 48116 48116 11410488 0 11410488 8591499 0 8591499 0 8591499 Part IV, Line 2b: The Medical Center acts as custodian for the funds of the residents and holds security deposits for the apartments. These funds are included in cash and cash equivalents and accounts payable in the accompanying balance sheets. Part X, Line 2: The Medical Center believes it has appropriate support for any tax positions taken affecting the annual filing requirements for the Medical Center, 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 liabilities in income tax expense if such interest and penalties are incurred. 1 1 X 1 X 1 X 1 1 0 0 27721 27721 0.00320 1279503 1063572 215931 0.02510 1307224 1063572 243652 0.02830 63612 6271 57341 0.00670 103014 47430 55584 0.00650 166626 53701 112925 0.01320 1473850 1117273 356577 0.04150 1 151016 15107 3135913 3015424 120489 X 1 1 1 1 Ashley Medical Center PO Box 450 612 Center Avenue North Ashley ND 584130450 amctoday.org 5001 X X X Swingbed Ashley Medical Center 1 0 0 1 X X X X X X X X X 18 1 0 1 1 X http://amctoday.org/services X X 1 18 1 http://amctoday.org/services 0 1 X 100.000000000000 200.000000000000 X 1 1 X X X X 1 X http://amctoday.org/services X http://amctoday.org/services X http://amctoday.org/services X X X X X 1 X 0 X X X X 1 X 0 0 Ashley Medical Center Part V, Section B, Line 5: To gather feedback from the community, residents of the area were given the opportunity to participate in a survey, from March 18th to April 26, 2019. Seventy-four AMC service area residents completed the survey. Additional information was collected through seven key informant interviews with community members conducted April 23, 2019. The input from the residents, who primarily reside in McIntosh 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. Ashley Medical Center Part V, Section B, Line 6b: McIntosh County Public Health assisted with the assessment. Ashley Medical Center Part V, Section B, Line 7d: Copies were left at our municipal offices downtown. Ashley Medical Center Part V, Section B, Line 11: The top four priorities addressed in our 6/30/2019 CHNA were:Attracting and retaining young families.Having enough child daycare services.Assisted living options.Not enough jobs with livable wages.The steering committee determined that as far as attracting and retaining young families to the community the Ashley Medical Center can not address our local economical attractions other than maintaining our financial liability. As an agricultural based community the struggling farm economy is a major concern.At the time our steering committee met the issue with having enough daycare was no longer an issue that needed to be addressed as a new daycare had recently opened to eliminate the current need.The assisted living option is still on our radar to be further analyzed for feasibility, with possible implementation in future.The issue of not having enough jobs with a livable wage is also impossible for the Ashley Medical Center to address in our struggling agricultural economy. The Ashley Medical Center continually tries to address the needs of our community. In FY 2020, we met the needs of our community by assisting businesses, organizations, and the school with the current Covid healthcare emergency. We assisted with community education on infection controls, we supplied hand cleaning stations for businesses, and our local school.Assisted Living was also researched and discussed numerous times. The biggest holdback is available staffing and the situations of our current tenants in the apartments that would need to be converted.In August of 2020 we put 10 of our licensed nursing home beds into layaway to be more in line with our current demographic demand.In the spring of 2021, the Center for Rural Health, University of North Dakota (UND) School of Medicine and Health Sciences announced that the State Office of Rural Health (SORH) program has made funding available for North Dakota Critical Access Hospitals, to support hospitals with a CHNA Implementation Plan Funding Program.AMC received the funding and contracted with IHC Independent Healthcare Consultants to perform a financial reimbursement review of modeling and implementing an assisted living program.We received the review in June of 2021. At this time we did not have the staffing to implement the program. However, based on the review our board has determined that implementation of an Assisted Living Center should occur as soon as needed staff can be hired. 3 1 - Ashley Medical Center SNF 612 Center Ave N Ashley ND 584130450 Long Term Care Facility 2 - AMC Clinic Ashley 612 Center Ave N Ashley ND 584130450 Rural Health Clinic 3 - AMC Clinic Zeeland 203 South Main Zeeland ND 58581 Rural Health Clinic 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, is actual costs reported in the general ledger. The cost for medicaid on line 7b and subsidized health services reported on line 7g were determined using 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 organization reasonably estimates the portion of implicit price concessions that could have qualified for charity care based on historical data. An estimated 10% of implicit price concessions in 2020 are attributable to patients potentially eligible for charity care. Part III, Line 4: The financial statement footnote regarding implicit price concessions may be found on page 10 & 11 of the 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 & Medicaid Services. The costs themselves are a community benefit as the community would not receive these services if we did not provide them. Part III, Line 9b: It is the policy of the Ashley Medical Center to forego extraordinary collection efforts against an individual before the organization has made a reasonable effort to determine whether the individual is eligible for assistance under the hospital charity care policy. Those who qualify for financial assistance will not be charged more than the amount generally billed to other patrons for Emergency Services (described in the EMTALA) or Medically Necessary services. The hospital billings and collections policy provides written notice at least 30 days prior to initiation collection actions. The hospital does not send patient accounts to collections until at least 120 days after the date of the first invoice. If a patient applies for financial assistance within 240 days of the date of the first invoice the hospital will pull that account or invoice back from collections. Part VI, Line 2: The Ashley Medical Center conducts an annual program review to evaluate current programs as well as determine any future programs that may be needed within our healthcare community. Part VI, Line 3: The Ashley Medical Center provides insurance counseling throughout the year to our patients and provides contact information for state and federal programs. We provide patients of need with a copy of our financial assistance program and post it at various locations throughout the facility ER, admissions, and AMC Clinic. Our financial assistance program and its summary is posted to our website. Part VI, Line 4: Ashley Medical Center (AMC) provides health care services to a rural and frontier geography that includes the cities of Ashley, Lehr, Zeeland and Wishek in McIntosh County. In Logan County we serve the cities of Gackle, Fredonia, and Napoleon. Dickey County cities include Ellendale and Forbes. In Emmons County we have patients from Hague and Strasburg. We also have patients from Kulm located in LaMoure County. All the preceding counties are located in North Dakota. In South Dakota we serve patients from Long Lake and the Leola area located in McPherson County as well as Eureka in Campbell County. In total we serve around 3500 people. There are approximately 3.5 persons per square mile, compared to about 80 per square mile across the United States. AMC strives to provide access to the best quality of care, regardless of the geographic barrier.Socio-Economic Status: Socio-Economic Status: McIntosh County has a high number of Medicare recipients, with 30.7% over 65 in 2018. The median income for a household is $50,739. The per capita income for the county is $32,389, 13.6% of the population is below the poverty level. Because of the low income levels, it is imperative that the patients be able to have access to the highest levels of medical care, without having to travel great distances and incur great costs.Race and Ethnicity: The racial makeup of McIntosh Co is 96.3% White, 0.05% Black or African American, 0.7% Native American, 0.29% Asian, 1.5% Pacific Islander, 0.00% from other races and 0.9% from two or more races. 2.4% of the population is Hispanic or Latino.The Ashley Medical Center serves as a "hub" for community-based health services, integrating different levels of care and services through one organizational structure. We are essential to our patients not only for acute care and emergency care services but also are the link for primary care, nursing home services, elder care services and living structures. AMC extends beyond the standard definition of a hospital.AMC serves an ever growing vulnerable population. This is due to the high number of elderly in our service area. The Medicare factor exacerbates access issues related to geographical considerations, income disparity, lower insurance coverage, and greater health disparities. Part VI, Line 5: The Ashley Medical Center (AMC) is a non-profit, community owned hospital located in Ashley, North Dakota. AMC is governed by a publicly elected nine-member board of directors. These members are residents of our community. It is the largest hospital complex in McIntosh County and serves an approximate 50-mile radius around Ashley. AMC extends medical staff privilieges to all qualified physicians in its community.It is the policy of the Ashley Medical Center to provide as direct services medical emergency procedures as a first response to common life-threatening injuries and acute illness. Services are available to all residents, patients, and visitors regardless of age, race, national origin, disability, or ability to pay.In Fiscal Year 2021 the Ashley Medical Center continued its cooperation with Bismarck State College in bringing the Dakota Nursing Program to the community of Ashley. We currently are hosting an RN course, having 5 students pursuing an RN Degree.The Ashley Medical Center continually tries to address the needs of our community. In FY 2021 we met the needs of our community by assisting businesses, organizations, and the school with the current covid healthcare emergency. We assisted with community education on infection controls, we supplied hand cleaning stations for businesses, our local parks, and our local school.Our Heart Check wellness clinic was put on hold due to COVID. Though numerous requests for us to continue with this vital health screening program, we revised it to enable us to provide the screening individually at any time during the calendar quarter of their birthdates. We offer this screening at a reduced rate of $50, our regular lab charges are $205 for the tests provided. X X 0 0 0 0 0 0 0 0 0 Lori Bichler Nurse Practitioner 188303 0 0 0 0 0 5799 0 21660 0 215762 0 0 0 Tara Brandner Nurse Practitioner 143948 0 0 0 0 0 4527 0 30652 0 179127 0 0 0 Kathy Jenner Family member of board member 111465 Employee Compensation 0 Emaline Schlepp Family member of board member 19621 Employee Compensation 0 Form 990, Part VI, Section A, line 1 The Executive Committee shall consist of the President, the Vice President, the Secretary and two additional members of the Board of Directors, elected by the Board of Directors at its organization meeting following the annual meeting of the members. The Executive Committee shall have the power to transact all regular business of the corporation during the period between the meetings of the Board of Directors, subject to any prior limitation imposed by the Board of Directors and with the understanding that all matters of major importance will be referred to the Board of Directors. The Executive Committee currently operates with the President, Vice President, Secretary and one additional board member. Form 990, Part VI, Section A, line 6 Membership or stockholders are given voting rights by making a $100 contribution to the Ashley Medical Center. Form 990, Part VI, Section A, line 7a All members that have made a $100 donation to the Ashley Medical Center are able to elect our Board of Directors. Form 990, Part VI, Section B, line 11b All board members received a copy of the 990 in the monthly board packet, which is reviewed at the board meeting prior to being filed with the IRS. Form 990, Part VI, Section B, line 12c The conflict of interest policy covers the board of directors and officers. The directors and officers are required to annually disclose any potential conflicts. The board of directors reviews for conflicts. If a conflict is identified the person must abstain from voting and remove themselves from discussions. Form 990, Part VI, Section B, line 15 The compensation for Eric Heupel was approved by the independent board using comparative data. The deliberation process for reasonable compensation was substantiated in the minutes. The CFO salary is annually determined by the board and compared to the state hospital association salary survey. Form 990, Part VI, Section C, line 19 The organization makes its governing documents, conflict of interest policy, and financial statements available to the public upon request. Management is responsible for honoring these requests.