2026-05-14T13:05:32-05:00 2025-06-30 161131146 BONADIO & CO LLP 171 SULLYS TRAIL PITTSFORD NY 14534 990 2024-07-01 450306787 CAVALIER COUNTY MEMORIAL HOSPITAL ASSOCIATION CAVA 7012566100 909 2ND ST LANGDON ND 58249 TODD CHRISTENSEN INTERIM CEO 7012566100 2026-05-14 1 1 AIMEE JOZIC P01329472 5853811000 2026-05-14 2024 2025-03-06 01:10:19Z LANGDON PRAIRIE HEALTH TODD CHRISTENSEN 909 2ND ST LANGDON ND 58249 13015296 0 X HTTPS://WWW.LPH.HOSPITAL/HOME X 1969 ND LPH IS DEDICATED TO EXCELLING AT PROVIDING HIGH-QUALITY, COMPASSIONATE HEALTHCARE TO ALL WE SERVE. 7 7 111 7 0 0 396122 837651 13392815 11951276 45558 54477 186759 171892 14021254 13015296 7394 0 0 0 6125035 7168591 0 0 0 8135959 7400423 14268388 14569014 -247134 -1553718 16397218 16302792 2137913 3295541 14259305 13007251 STANDING PROUDLY ON THE TRADITIONS AND PERSEVERANCE OF OUR HOSPITAL FOUNDERS, LPH IS DEDICATED TO EXCELLING AT PROVIDING HIGH-QUALITY, COMPASSIONATE HEALTHCARE TO ALL WE SERVE. 0 0 10955117 11951276 PROVIDE PATIENT HEALTHCARE SERVICES INCLUDING HOSPITAL AND CLINIC SERVICES TO THE SURROUNDING COMMUNITY. THE ORGANIZATION PROVIDED APPROXIMATELY $45,000 OF CHARITY CARE DURING THE YEAR. 10955117 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 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 40 0 1 111 1 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 X TODD CHRISTENSEN 7012566100 909 2ND ST LANGDON ND 58249 STEVE HART PRESIDENT 2.00 X X 0 0 0 JACKIE DVORAK SECRETARY 2.00 X X 0 0 0 KATHRYN KOPF VICE PRESIDENT 1.00 X X 0 0 0 CHRYRISSE REGEHR TREASURER 1.00 X X 0 0 0 STEPHANIE WELSH DIRECTOR 1.00 X 0 0 0 AARON DAHL DIRECTOR 1.00 X 0 0 0 MARQUS MARITZ DIRECTOR 1.00 X 0 0 0 RICHARD WAYNE REID CEO 40.00 X 281610 0 19386 MICHELLE SKILLINGS CNO 40.00 X 144443 0 9580 DARLA RODER COO 40.00 X 146805 0 18389 MARI CHAMBERS CFO 40.00 X 69688 0 0 COURTNEY FEIL-SHORT NURSE PRACTITIONER 40.00 X 213135 0 6126 CATHERINE TAYLOR PHARMACY DIRECTOR 40.00 X 143932 0 7567 DAWN HERTL REGISTERED NURSE 40.00 X 158373 0 2615 EMEKA OKWUDILI MEDICAL DOCTOR 40.00 X 446426 0 5717 ELIZABETH SILLERS FAMILY NURSE PRACTITIONER 40.00 X 122637 0 22110 1727049 0 91490 8 0 1 0 MCKESSON 6555 STATE HIGHWAY 161 IRVING TX 75039 MEDICAL SUPPLIES 832795 NATIONAL MEDICAL RESOURCES INC 2792 E BROADWAY AVE BISMARCK ND 58501 LOCUMS PROVIDERS 747576 SANFORD HEALTH 1305 W 18TH ST SIOUX FALLS SD 57117 HEALTH INSURANCE 721934 GE MEDICAL SYSTEMS ULTRASOUND 3200 N GRANDVIEW BLVD WAUKESHA WI 53188 MEDICAL EQUIPMENT 467620 PRONEXUS 115 SULLYS TRAIL PITTSFORD NY 14534 ACCOUNTING SERVICES 449667 22 305823 531828 837651 PATIENT REVENUE 621400 10916508 10916508 340B PHARMACY REVENUE 621400 866592 866592 AMBULANCE REVENUE 621910 168176 168176 11951276 54477 54477 21734 0 21734 21734 21734 OTHER 900099 150158 150158 150158 13015296 11951276 0 226369 X 647960 518368 129592 5522368 4333103 1189265 84531 67625 16906 485316 388253 97063 428416 342733 85683 11989 11989 61925 61925 54149 35498 18651 89751 49352 40399 53870 39508 14362 609740 174305 435435 208045 142345 65700 76263 49932 26331 144743 114347 30396 941203 743550 197653 113408 667 112741 CONTRACTED SERVICES 1294034 1132270 161764 PURCHASED SERVICES 786766 368871 417895 FEES 680485 680485 MEDICAL SUPPLIES 440829 440378 451 1833223 1333527 499696 14569014 10955117 3613897 0 4507602 4497041 1649673 1372482 168072 230368 220501 176515 13918092 7205091 6858888 6713001 2702618 3130513 289864 182872 16397218 16302792 911348 790258 229462 997103 2505283 2137913 3295541 X 14259305 13007251 14259305 13007251 16397218 16302792 -1553718 301664 0 X X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 13167 13167 8869632 4577897 4291735 106708 106651 57 4928585 2520543 2408042 6713001 DUE TO THIRD PARTY PAYABLES 2322322 LEASE LIABILITY 182961 2505283 13316960 301664 301664 13015296 0 13015296 14569014 0 14569014 0 14569014 1 1 X 0 0 1 1 0 1 1 146366 146366 0.01000 502243 407369 94874 0.00650 648609 407369 241240 0.01650 648609 407369 241240 0.01650 1 178267 6787287 6498752 288535 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 25 1 0 1 1 X HTTPS://LPH.HOSPITAL/PARTNERING-FOR-A-HEALTHIER-COMMUNITY/ X 1 25 1 HTTPS://LPH.HOSPITAL/PARTNERING-FOR-A-HEALTHIER-COMMUNITY/ 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. A STANDARD PROCESS OF GATHERING COMMUNITY INPUT WAS DEVELOPED, USING A CHNA SURVEY DEPLOYED TO THE HOSPITAL'S LOCAL EXPERT ADVISORS AND THE GENERAL PUBLIC TO GAIN INPUTON LOCAL HEALTH NEEDS AND THE NEEDS OF PRIORITY POPULATIONS. LOCAL EXPERT ADVISORS WERE LOCAL INDIVIDUALS SELECTED ACCORDING TO CRITERIA REQUIRED BY THE FEDERAL GUIDELINES AND REGULATIONS AND THE HOSPITAL'S DESIRE TO REPRESENT THE REGION'S GEOGRAPHICALLY DIVERSE POPULATION. SURVEY INPUT FROM 181 COMMUNITY MEMBERS WAS RECEIVED. SURVEY RESPONSES WERE GATHERED BETWEEN JULY 2025 AND AUGUST 2025. INPUT 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 THE PUBLISHED REPORT. CAVALIER COUNTY MEMORIAL HOSPITAL PART V, SECTION B, LINE 6B: CAVALIER COUNTY MEMORIAL HOSPITAL CONDUCTED A COMMUNITY HEALTH NEEDS ASSESSMENT WITH QHR HEALTH.P CAVALIER COUNTY MEMORIAL HOSPITAL PART V, SECTION B, LINE 11: MENTAL HEALTH AND EXCESS DRINKING AND DRUG/SUBSTANCE ABUSEMENTAL HEALTH WAS THE #1 COMMUNITY-IDENTIFIED HEALTH PRIORITY WITH 80.7% OF RESPONDENTS RATINGIT AS EXTREMELY IMPORTANT TO BE ADDRESSED IN THE COMMUNITY. EXCESS DRINKING WAS THE #2 COMMUNITY-IDENTIFIED HEALTH PRIORITY WITH 69.3% OF RESPONDENTS RATING IT AS EXTREMELY IMPORTANT TO ADDRESS IN THE COMMUNITY. DRUG AND SUBSTANCE ABUSE WAS IDENTIFIED AS THE #7 HEALTH PRIORITY WITH 61.4% OF SURVEY RESPONDENTS RATING IT AS EXTREMELY IMPORTANT TO BE ADDRESSED. THE HOSPITAL PROVIDES VARIOUS SERVICES TO RESPOND TO THIS HEALTH PRIORITY, INCLUDING:- PARTICIPATING IN A BEHAVIORAL MENTAL HEALTH TASK FORCE A LOCAL GROUP THAT CONSISTS OF REPRESENTATIVESFROM 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.-ALCOHOLICS ANONYMOUS (AA) SERVICES ARE NOW PROVIDED AT WALHALLA CLINIC.- LPH HAS A PROVIDER TRAINED IN CHILD BEHAVIORAL HEALTH.FUTURE STEPS EXPECTED TO ADDRESS THIS PRIORITY NEED INCLUDE: 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 WITHTHEIR 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. DEVELOP AND SUPPORT PROVIDERS WHO ARE INTERESTED IN BEHAVIORAL HEALTH.CANCER, DIABETES, HEART DISEASECANCER WAS IDENTIFIED AS THE #3 HEALTH PRIORITY WITH 64.6% OF SURVEY RESPONDENTS RATING IT ASEXTREMELY IMPORTANT TO BE ADDRESSED. DIABETES WAS IDENTIFIED AS THE #5 HEALTH PRIORITY WITH 61.3% OF RESPONDENTS RATING IT AS EXTREMELY IMPORTANT TO ADDRESS. IN THE COMMUNITY SURVEY, HEART DISEASE WAS IDENTIFIED AS THE #6 HEALTH PRIORITY WITH 59.8% OF RESPONDENTS RATING IT AS EXTREMELY IMPORTANT TO ADDRESS.STEPS TAKEN TO ADDRESS THIS NEED INCLUDE: WELLVANA HEALTH COLLABORATIVE LPH ACCOUNTABLE CARE ORGANIZATION (ACO). COMPREHENSIVE PRIMARY CARE SERVICES. CHRONIC CARE MANAGEMENT SERVICES CHRONIC DISEASE PATIENTS RECEIVE PHONE CALLS EVERYOTHER WEEK FROM HEALTHCARE PROFESSIONALS TO REVIEW HOW THEIR CARE IS GOING. TRANSITIONAL CARE MANAGEMENT SERVICES PATIENTS DISCHARGED FROM THE HOSPITAL WITH ACHRONIC CONDITION RECEIVE A CALL TO ENSURE A FOLLOW-UP APPOINTMENT IS SCHEDULED AT THECLINIC. 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 PROVIDESCREENING 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 MEALSFOR 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-UPSVISITING OUTREACH PROVIDERS: CARDIOLOGY DERMATOLOGY OB/GYN ONCOLOGY ORTHOPEDICS PAIN MANAGEMENT GIFUTURE STEPS EXPECTED TO ADDRESS THIS PRIORITY NEED INCLUDE: WORK WITH COMMERCIAL INSURANCES TO BROADEN CHRONIC CARE MANAGEMENT SERVICES TOALL PATIENTS. INCREASE EDUCATION AND AWARENESS AROUND CHRONIC DISEASES ON SOCIAL MEDIA. INITIATE COMMUNITY PARAMEDIC PROGRAM, INCLUDING DISEASE MONITORING ANDMEDICATION MANAGEMENT FOR CHF AND COPD. EXPLORE POTENTIAL PROGRAMS TO PROVIDE CARE IN A PATIENT'S HOME AS AN ALTERNATIVE TOLONG- TERM CARE. EVALUATE THE POTENTIAL OF INCREASING SPECIALTY ROTATIONS FOR SERVICES THAT ARE HEAVILY UTILIZED.HEALTHCARE SERVICES: PHYSICAL PRESENCE AND AFFORDABILITY THE PHYSICAL PRESENCE OF HEALTHCARE SERVICES WAS IDENTIFIED AS THE #4 HEALTH PRIORITY WITH 62.8%OF RESPONDENTS RATING IT AS EXTREMELY IMPORTANT TO ADDRESS. AFFORDABILITY OF HEALTHCARE SERVICES WAS THE #8 IDENTIFIED HEALTH NEED IN THE COMMUNITY WITH 61.1% OF SURVEY RESPONDENTS RATING IT AS EXTREMELY IMPORTANT TO BE ADDRESSED. 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 ANDAPPLICATIONS 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 ANDFEATURES INFORMATION ABOUT HOSPITAL SERVICES AND HEALTH TIPS.FUTURE STEPS EXPECTED TO ADDRESS THIS PRIORITY NEED INCLUDE: 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, 2025 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 2025. 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. X X 0 0 0 0 0 0 0 0 0 EMEKA OKWUDILI MEDICAL DOCTOR 446426 0 0 0 0 0 0 0 5717 0 452143 0 0 0 RICHARD WAYNE REID CEO 281610 0 0 0 0 0 0 0 19386 0 300996 0 0 0 COURTNEY FEIL-SHORT NURSE PRACTITIONER 213135 0 0 0 0 0 5279 0 847 0 219261 0 0 0 DARLA RODER COO 146805 0 0 0 0 0 4564 0 13825 0 165194 0 0 0 DAWN HERTL REGISTERED NURSE 158373 0 0 0 0 0 2615 0 0 0 160988 0 0 0 MICHELLE SKILLINGS CNO 144443 0 0 0 0 0 3069 0 6511 0 154023 0 0 0 CATHERINE TAYLOR PHARMACY DIRECTOR 143932 0 0 0 0 0 1056 0 6511 0 151499 0 0 0 A CITY OF LANGDON NORTH DAKOTA 456002108 515679AL2 2010-03-25 2500000 HOSPITAL RENOVATION PROJECT 0 0 0 A 2500000 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 A 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 THE ORGANIZATION UTILIZES TO DETERMINE ITS CEO'S COMPENSATION IS AS FOLLOWS. UPON EXPIRATION OF CEO'S CONTRACT, THE ORGANIZATION'S BOARD OF TRUSTEES (BOARD) CALLS FOR AN EXECUTIVE SESSION TO DISCUSS THE CEO'S CONTINUED/DISCONTINUED EMPLOYMENT. UPON APPROVAL TO CONTINUE THE CEO'S EMPLOYMENT, THE BOARD 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 BOARD PASSES A MOTION TO RATIFY THE COMPENSATION AGREEMENT BETWEEN THE BOARD AND CEO. FINALLY, REQUIRED DELIVERABLES AND OTHER MEASURABLE INDICATORS ARE MEMORIALIZED IN A FORMAL AGREEMENT OR CONTRACT WITH THE CEO. THE PROCEDURES UTILIZED BY THE ORGANIZATION TO SET WAGES FOR SUBORDINATE OFFICERS AND ALL OTHER EMPLOYEES IS DETERMINED BY THE CEO WHO IS EMPOWERED BY THE BOARD 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 IX, LINE 24E OTHER: PROGRAM SERVICE EXPENSES 148,185. MANAGEMENT AND GENERAL EXPENSES 256,854. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 405,039. EQUIPMENT RENTAL: PROGRAM SERVICE EXPENSES 392,154. MANAGEMENT AND GENERAL EXPENSES 7,285. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 399,439. PHARMACEUTICALS: PROGRAM SERVICE EXPENSES 322,764. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 322,764. REPAIRS AND MAINTANCE: PROGRAM SERVICE EXPENSES 269,817. MANAGEMENT AND GENERAL EXPENSES 4,968. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 274,785. DUES/SUBSCRIPTIONS: PROGRAM SERVICE EXPENSES 11,882. MANAGEMENT AND GENERAL EXPENSES 86,798. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 98,680. COLLECTIONS: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 90,519. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 90,519. OTHER FOOD: PROGRAM SERVICE EXPENSES 51,959. MANAGEMENT AND GENERAL EXPENSES 19,587. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 71,546. LICENSES: PROGRAM SERVICE EXPENSES 66,201. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 66,201. MINOR EQUIPMENT: PROGRAM SERVICE EXPENSES 34,433. MANAGEMENT AND GENERAL EXPENSES 9,636. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 44,069. SHIPPING./POSTAGE: PROGRAM SERVICE EXPENSES 18,831. MANAGEMENT AND GENERAL EXPENSES 5,606. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 24,437. TRAINING: PROGRAM SERVICE EXPENSES 17,301. MANAGEMENT AND GENERAL EXPENSES 4,164. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 21,465. TELEPHONE: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 14,279. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 14,279. FORM 990. PART XII, LINE 2C THE PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR.