2018-05-14T15:11:43-05:00 2017-06-30 390758449 Wipfli LLP PO Box 12237 Green Bay WI 543072237 990 2016-07-01 770637498 McKenzie County Healthcare Systems Inc MCKE 7018423000 516 N Main Watford City ND 58854 Daniel Kelly CEO 7018423000 2018-05-14 1 Terri Rexrode CPA MST P00096513 9206620016 2018-05-14 2016 2022-09-23 18:48:47Z Daniel Kelly 516 N Main Watford City ND 58854 20970332 0 X www.mckenziehealth.com X 2004 ND Health care service provider. 9 9 228 45 330572 -121460 7587619 4424608 15451871 15527427 3591 -83076 469874 420345 23512955 20289304 0 0 0 0 8157714 8441338 0 0 0 11036600 9428784 19194314 17870122 4318641 2419182 37740642 67521366 7466591 34828133 30274051 32693233 X McKenzie County Healthcare Systems is a faith-based organization dedicated to professional, compassionate and quality healthcare. 0 0 8088787 0 9912555 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 - 310. Total swing bed days - 748. MCHS offers various other services. They offer endoscopic exams once a month by a contracted provider. Total Outpatient Surgeries - 99. The emergency room is open 24 hours a day, 7 days a week. Due to decreased oil activity the number of visits has decreased. Total Emergency Room visits - 3,153. 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 - 687. Total outpatient procedures - 32,241. 3003076 0 3252368 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. 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, restorational nursing, laundry, housekeeping, beautician services, and activity programs are offered. Visitors are always welcome as well as children. Children are welcome to visit and play on the fenced outdoor playground equipment. 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 77.3%. The Basic Care Unit total percent of occupancy has been 71.8%. 2032607 0 1907590 The MCHS Clinic (Rural Health Clinic) maintains the same mission as the Hospital. It provides care Monday thru Friday. The Medical Director, augmented by locum physicians, provide Emergency Room Coverage at the hospital 24 hours a day x 7 days a week. The providers also make visits to the Good Shepherd Home weekly. The Visiting Nurse Program has been a great asset to the clinic, providing care to homebound patients within our community. 224284 0 327044 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 91%. 554635 0 0 Wellness Center 778919 0 327044 13903389 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 0 0 0 1 0 0 0 0 0 0 1 1 0 0 0 1 45 0 228 1 1 1 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 0 0 X Daniel Kelly 7018423000 516 North Main Street Watford City ND 58854 Myron Hovet Director 1.00 2.00 X 0 0 0 Tammy James Director 1.00 X 0 0 0 Nancy Jellesed Director 1.00 X 0 0 0 Larry Larsen Director 1.00 X 0 0 0 Neal Shipman Director 1.00 X 0 0 0 Patsy Levang President 2.00 2.00 X X 0 0 0 Kelly Peterson Vice President 2.00 2.00 X X 0 0 0 Michon Sax Secretary 2.00 X X 0 0 0 Scott Swenson Treasurer 2.00 X X 0 0 0 Daniel Kelly CEO 40.00 10.00 X 451299 0 17440 Susie Curtis CFO 40.00 X 53950 0 5565 Cheryl Faulkner CNO 40.00 X 104086 0 5464 Michael Curtis CAO 40.00 X 113521 0 9384 Dr Gary Ramage Physician 40.00 X 330587 0 41479 Dr Janis Green nurse practitioner 40.00 X 140216 0 3427 Carmen Lawson RN Director of Nursing 40.00 X 170049 0 1614 Dr Jodi Moore Physician 40.00 X 116050 0 1994 1479758 0 86367 7 0 1 0 JE Dunn 800 Washington Ave N Ste 600 Minneapolis MN 55401 Construction Services 5123057 Northland Family Physicians 1451 44th Ave S Unit A Grand Forks ND 58201 Contract ER Physican Services 655751 CPI Group 7400 E Orchard Rd Ste 270 Greenwood Village CO 80111 Architectual Services 494450 Wipfli CPAs & Consultants PO Box 3160 Milwaukee WI 53201 Auditing and Accounting Services 192595 Guardian Healthcare 105 W Park Dr Ste 100 Brentwood TN 37027 Contract Nursing Services 184292 6 1884865 1810632 729111 4424608 Hospital Patient Service Revenue 621400 9555393 9555393 Nursing Home Service Revenue 621400 3252368 3252368 Clinic Service Revenue 621400 1907590 1907590 Wellness Center 621400 485032 379978 105054 Assisted Living Service Revenue 621400 327044 327044 15527427 15354 15354 135268 135268 300676 582057 -281381 -281381 -49406 -231975 541 98971 -98430 -98430 -98430 340 B Revenue 621400 301285 301285 EHR Incentive 621400 55877 55877 Cafeteria and Dietary Revenue 900099 12379 12379 196917 196917 566458 20289304 15399557 330572 134567 X 800005 800005 6315422 5304308 1011114 99414 82301 17113 744230 452271 291959 482267 379491 102776 5192 5192 62000 62000 3965671 3231639 734032 41968 41968 294887 160609 134278 1200 1200 410079 408949 1130 73511 22999 50512 34355 17411 16944 2426 2426 1091425 1091425 100242 93798 6444 Bad Debt & Collection 1403803 1403803 Program Supplies 1124969 1080100 44869 Equipment Rental & Main 521207 120886 400321 Dues and Subscriptions 45502 18070 27432 250347 32903 217444 17870122 13903389 3966733 0 740 5214 417810 -41334 6797392 5918840 1545922 1827882 -7366 0 56944 41324 86335 79692 62331937 10565899 24071188 51766038 199596 200000 4572081 7723710 37740642 67521366 2053006 8135665 139692 83815 5225745 26439568 48148 169085 7466591 34828133 X 20441761 22651215 9832290 10042018 30274051 32693233 37740642 67521366 2419182 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 1450 1450 0 Part II-B, Line 1: The organization is a member of American Hospital Association, 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 19154639 5029825 14124814 7415278 5536074 1879204 34617073 34617073 51766038 Assets Restricted as to Use 7448407 Due from Related Parties 100000 Cash Surrender Value of Life Insurance 175303 7723710 Postretirement Benefit Obligation 169085 169085 19257830 735702 735702 18522128 1767176 1767176 20289304 17048376 582057 582057 16466319 1403803 1403803 17870122 Part XI, Line 2d - Other Adjustments: Net assets released from restrictions 153,645. Rental Expenses 582,057. Part XI, Line 4b - Other Adjustments: Bad Debt Expense 1,403,803. Restricted Contributions and Pledges 363,373. Part XII, Line 2d - Other Adjustments: Rental Expenses 582,057. Part XII, Line 4b - Other Adjustments: Bad Debt Expense 1,403,803. 1 1 X 1 X 1 X 1 1 0 0 40138 40138 0.00240 2258965 2163082 95883 0.00580 2299103 2163082 136021 0.00820 5944185 5329456 614729 0.03730 5944185 5329456 614729 0.03730 8243288 7492538 750750 0.04550 3203 3203 0.00020 3203 3203 0.00020 1 1278887 0 3789138 3718363 70775 X 1 1 1 1 McKenzie County Healthcare Systems Inc 516 N Main Watford City ND 58854 http://mckenziehealth.com/ 5051A X X X X X Swing Bed Unit McKenzie County Healthcare Systems Inc 1 0 0 1 X X X X X X X X X 15 1 0 0 1 X See Supplemental Information X X 1 15 1 See Supplemental Information 0 1 X 100.000000000000 200.000000000000 X X X X 1 1 X X X 1 X See Supplemental Information X See Supplemental Information X See Supplemental Information 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 7d: CHNA Website:https://www.mckenziehealth.com/wp-content/uploads/2016/04/3-CHNA-Final-Report-3.pdfImplementation Strategy Website:https://www.mckenziehealth.com/wp-content/uploads/2016/04/Implementation-Strategy-Planning.pdf McKenzie County Healthcare Systems Inc Part V, Section B, Line 11: Availability of Specialists: We have been very aggressive in developing the telemedicine program and we currently have the following service lines available: Dietitian Consults, Behavioral Health, Genetic Counseling, and Pediatric Rheumatology. We will continue to create partnerships to grow our telemedicine services in order to better meet the healthcare needs in our community. Ability to Retain Physicians in the Area: We are aggressively seeking physicians through a variety of recruitment methods. Physician recruitment will be an ongoing process in our healthcare system for years to come as we strive to meet the needs of our community. Adult Drug Use and Abuse: We have implemented drug and substance abuse counseling with behavioral health specialists through our telemedicine programs. We plan to devote more attention to this initiative in 2018 as we will be completing our new hospital construction project and relocating to the new facility. 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:http://mckenziehealth.com/wp-content/uploads/2016/03/Charity-Care-Application-Process.pdfFAP Application Website:https://www.mckenziehealth.com/wp-content/uploads/2016/04/Sliding-Fee-Schedule-Application-1.pdfFAP Plain Language:http://mckenziehealth.com/wp-content/uploads/2016/03/Charity-Care-Application-Process.pdf Form 990, Schedule H, Part V, Line 16i The organization is in a community where the only language required is english for their documentation and thus have only provided the FAP in english. 5 1 - McKenzie County Clinic 525 N Main St Watford City ND 58854 Rural Health Center 2 - Good Shepherd Home 709 4th Ave NE Watford City ND 58854 LT Care & Basic Care 3 - Connie Wold Wellness Center 200 8th St NE Watford City ND 58854 Wellness Center 4 - Horizons 705 4th Ave NE Watford City NE 58854 Assisted Living Complex 5 - Heritage Manor 709 4th Ave NE Watford City NE 58854 Apartment Complex 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 Rural Health Clinic in the subsidized services calculation. Part I, Line 7, Column (f): The Bad Debt expense included on Form 990, Part IX, Line 25, Column (A), but subtracted for purposes of calculating the percentage in this column is $ 1,403,803. Part III, Line 2: This is the amount of bad debt expense recorded on the financial statements at 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 collectablility 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: N/A X X X 0 0 0 0 0 0 0 0 0 Daniel Kelly CEO 243653 0 207646 0 0 0 15815 0 1625 0 468739 0 0 0 Dr Gary Ramage Physician 330163 0 424 0 0 0 15543 0 25936 0 372066 0 0 0 Carmen Lawson RN Director of Nursing 169630 0 419 0 0 0 1614 0 0 0 171663 0 0 0 Leslie Kelly Spouse of CEO 48505 Employee Salary 0 Samuel Kelly Son of CEO 66107 Employee Salary 0 Danielle Kelly Daughter of CEO 34517 Employee Salary 0 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 15a 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 1,536,526. Management and general expenses 0. Fundraising expenses 0. Total expenses 1,536,526. Clinic MD Purchased Services: Program service expenses 253,022. Management and general expenses 0. Fundraising expenses 0. Total expenses 253,022. Nursing Home Purchased Services: Program service expenses 386,579. Management and general expenses 0. Fundraising expenses 0. Total expenses 386,579. Other Contractor Services: Program service expenses 1,055,512. Management and general expenses 0. Fundraising expenses 0. Total expenses 1,055,512. Administrative Purchased Services: Program service expenses 0. Management and general expenses 734,032. Fundraising expenses 0. Total expenses 734,032. McKenzie County Healthcare Systems Properties 516 N Main St Watford City ND 58854 462905447 Property Management ND 15503 709528 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 1 0 0 0 0 1 0 0 1 0 1 0 0 1 0 The Benefit Fund of McKenzie County Healthcare Systems Inc C 1884865 Actual The Benefit Fund of McKenzie County Healthcare Systems Inc E 100000 Actual