2026-05-15T10:55:59-05:00 2025-06-30 450250958 Eide Bailly LLP 4585 Coleman St Ste 200 Bismarck ND 58503 990 2024-07-01 450425948 Towner County Medical Center Inc TOWN 7019684411 PO Box 688 Cando ND 58324 Tammy Larson CFO 7019684411 2026-05-15 1 1 Lisa Chaffee CPA P00193453 7012551091 2026-05-15 2024 2025-03-06 01:10:19Z Ben Bucher PO Box 688 Cando ND 58324 16164418 0 X www.tcmedcenter.org X 1992 ND To acquire, maintain and further develop hospital, clinical, long term care, and other services in Cando and the surrounding area. 7 7 149 7 0 0 315570 527784 14267527 15518632 25165 43947 32481 1092 14640743 16091455 0 0 0 0 7799976 8546395 0 0 0 6613147 8857818 14413123 17404213 227620 -1312758 9348415 67487044 1402686 60854073 7945729 6632971 X Total quality comprehensive healthcare. Caring and compassionate health services for patients, residents, families and healthcare workers. Medical care for all life stages delivered by a professional and expert healthcare team. Commitment to our communities to maintain and ensure the ongoing provision of quality health services. The vision of Towner County Medical Center is to be the healthcare resource of choice for those who seek comprehensive quality health services. 0 0 14224974 15518632 I. IntroductionTowner County Medical Center was acquired from the Sisters of St. Francis, a Catholic religious order, in 1992. The community of Cando wanted to ensure itself that there would continue to be health care services available to not only the residents of Cando, but to the areas surrounding the community as well.Service to the community and the surrounding area is a hallmark of how we are here. The Medical Center provides diagnostic and therapeutic treatment to all, regardless of race, sex, religion, financial ability to pay, or any other area that could be deemed to be discriminatory. In addition to the core medical services, we are continually reaching out to surrounding communities assisting them in promoting a healthier community as well.The Medical Center provides preventative services to all patients and promotes awareness of these throughout the year. During breast cancer awareness month they have drawings for gift baskets throughout the month. During the month of November they provide lung cancer screening to patients at no charge. This past year these preventive promotions totaled $24,500 in expense for the facility. II. Uncompensated CareTowner County Medical Center provides uncompensated care to those in need of services, who either have limited resources or who may have fallen on hard times and are in need of relief in order to get back on their feet. The amount of traditional uncompensated care for the year ended June 30, 2025 was $377,000 which includes charity care and implicit price concessions. In many cases, we believe that the bad debt is in fact charity care, but individuals are too proud to come in and request charity. New policies and procedures have been developed in an effort to allow us to better identify these individuals, and to be able to classify them as they should be. In addition to uncompensated care, Towner County Medical Center also provides discounts to the Medicare and Medicaid programs. For the year ended June 30, 2025 those discounts totaled $2,498,000. 14224974 1 1 0 0 0 0 0 0 1 0 1 0 0 1 1 1 0 1 0 0 0 0 0 0 1 0 1 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 1 36 0 1 149 1 0 0 0 0 0 0 0 0 0 0 0 0 X 7 7 0 0 0 0 1 1 1 1 0 0 0 1 1 1 1 0 1 1 0 0 X Tammy Larson 7019682560 Highway 281 North Box 688 Cando ND 58324 David Wolsky-President Until 11/24)/Director (Beg 12/2024) 1.00 0.50 X X 0 0 0 Tom Belzer- Vice President (Until 11/24)/President (Beg 12/24) 1.00 1.00 X X 0 0 0 Michelle Gibbens-DirectorUntil 11/24)/Vice President (Beg 12/24) 1.00 0.50 X X 0 0 0 Greg Westlind Secretary/Treasurer (Until 10/24) 1.00 0.50 X X 0 0 0 Randina Bjornstad-Directuntil 11/24)/Secretary/Treas(Beg 12/24) 1.00 0.50 X X 0 0 0 John Peters Director 1.00 0.50 X 0 0 0 Mike Farbo Director 1.00 0.50 X 0 0 0 Melanie Wahl Director (Beg 11/2024) 1.00 0.50 X 0 0 0 Ben Bucher CEO 45.00 15.00 X 310912 0 39232 Tammy Larson CFO 45.00 15.00 X 210058 0 46361 Grant Lannoye Physician Assistant 45.00 0.00 X 301276 0 48350 Sam Held Family Nurse Practitioner 45.00 0.00 X 221182 0 46570 Jessica Larson Family Nurse Practitioner 45.00 0.00 X 186317 0 44369 Cassandra Ullyott Family Nurse Practitioner 45.00 0.00 X 193286 0 43376 Chantel Parker DON 45.00 0.00 X 101404 0 41779 1524435 0 310037 7 0 1 0 Resolution RCM PO Box 749124 Atlanta GA 30374 Revenue Cycle Management 533216 DMS Health Technologies PO Box 670747 Dallas TX 75267 Imaging Services 227608 Northstar Technology Group 3523 45th St S 100 Fargo ND 58104 IT Consultants 134554 Rural Medical Partners 389 Wren Drive Grand Forks ND 58201 Professional Services 101446 4 12415 167832 347537 527784 Net Patient Revenue 621110 11035759 11035759 Nursing Home Revenue 623000 4220081 4220081 Contracted Serv.-R/P 900099 55900 55900 Pharmacy Revenue 456110 2851 2851 204041 204041 15518632 384 384 5400 3893 1507 1507 1507 109178 65615 43563 43563 43563 3040 12415 3455 -415 -415 16091455 15518632 0 45039 X 620800 31040 589760 6496049 5969142 526907 173388 139068 34320 777040 585036 192004 479118 343309 135809 39310 39310 68083 68083 2491680 1633502 858178 4478 70 4408 204481 145149 59332 223322 108192 115130 659218 618780 40438 4958 4958 64462 33063 31399 1366037 1301056 64981 1699764 1566043 133721 239308 239308 Medical Supplies 1397026 1397026 Food 204056 204056 Subscriptions and Dues 105966 64484 41482 Bad Debt Expense 81000 81000 4669 4669 17404213 14224974 3179239 0 3431798 1275735 1684344 1490501 148800 148800 279997 375580 175761 256994 5735839 5075934 523326 659905 187354 18363 2917035 63261166 9348415 67487044 1318004 1317719 4599 36369 80083 0 59499985 1402686 60854073 X 7945729 6632971 7945729 6632971 9348415 67487044 -1312758 0 X 0 1 X 0 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 1 X 591046 591046 0 5144793 4484888 659905 659905 Employee Retention Credit Receivable 2880481 Related Party Receivable 933969 Right of Use Assets 59446716 63261166 Estimated third-party payor settlement 112001 Lease Liability 59387984 59499985 X 16098420 -383 -383 16098803 -7348 -7348 16091455 17411178 7348 7348 17403830 383 383 17404213 Part IV, Line 2b: The Organization holds funds under an agency relationship for the residents of the long-term nursing care facility. These funds are included in cash with a corresponding liability in accounts payable. Funds held totaled $36,369 and $4,599 as of June 30, 2025 and 2024. Part X, Line 2: The Medical Center believes they have 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 Medical Center would recognize future accrued interest and penalties related to unrecognized tax benefits and liabilities in income tax expense if such interest and penalties are incurred. Part XI, Line 2d - Other Adjustments: Interest Expense in Revenue on Financial Statements -383. Part XI, Line 4b - Other Adjustments: Fundraising Expenses -3,455. Rental Expenses Reported in Expenses on Financial Statements -3,893. Part XII, Line 2d - Other Adjustments: Fundraising Expenses 3,455. Rental Expenses Reported in Expenses on Financial Statements 3,893. Part XII, Line 4b - Other Adjustments: Interest Expense in Revenue on Financial Statements 383. 2025 TCMC Golf Classic 15455 12415 3040 1935 720 208 592 15455 12415 3040 1935 720 208 592 3455 -415 1 1 X 1 X 1 X 0 1 0 0 45000 45000 0.00260 2849729 2633218 216511 0.01240 2894729 2633218 261511 0.01500 265552 169364 96188 0.00550 60187 60187 0.00350 1088786 500706 588080 0.03380 1414525 670070 744455 0.04280 4309254 3303288 1005966 0.05780 1 321140 31472 5449636 5465001 -15365 X 1 1 1 1 Towner County Medical Center 228 1st Ave Cando ND 58324 www.tcmedcenter.org 5077 X X X X One provider-based clinic Towner County Medical Center 1 0 0 1 X X X X X X X X X 24 1 0 1 1 X http://tcmedcenter.org/ X 1 24 1 http://tcmedcenter.org/ 0 1 X 100.000000000000 200.000000000000 1 1 X X X X 1 X https://tcmedcenter.org/resources/ X https://tcmedcenter.org/resources/ X https://tcmedcenter.org/resources/ X X X X X X 1 X 0 X X X X 1 X 0 0 Towner County Medical Center Part V, Section B, Line 5: In March 2024, TCMC selected Cibolo Health to facilitate the 2025 CHNA process. At that time, a CHNA liaison was selected locally, who served as the main point of contact with Cibolo Health for the process. A steering committee composed of representatives from healthcare, public health, community organizations, and the community at large was formed that was responsible for planning and implementing the process locally. Community leaders, representing the broad interests of the community, took part in one-on-one key informant interviews. A community group consisting of twelve community members met on December 2, 2024. They were introduced to the needs assessment process, reviewed basic demographic information about the community and served as a focus group. A survey was distributed throughout the hospital service area as an additional tool for collecting qualitative data from the community at large - specifically, information related to community-perceived health needs. The survey was open from February 19, 2025 to March 31, 2025. A community meeting was held on April 30, 2025 and they were presented with the survey results, findings from key informant interviews, and a wide range of secondary data relating to the general health of the population in the service area. The group then identified and prioritized the community's health needs. Meetings were held over the following months and an Implementation Plan was completed and approved. Towner County Medical Center Part V, Section B, Line 6b: Towner County Public Health Towner County Medical Center Part V, Section B, Line 11: The following needs were identified in the most recently completed CHNA:1. Availability of mental health services2. Having enough child daycare services3. Not getting enough and not enough places for exercise/physical activity4. Depression/anxiety- all agesNeeds identified in the prior CHNA were as follows:1. Mental Health Services2. Retaining Young Families3. Cost of Healthcare4. ChildcareTowner County Medical Center has been working to address each of these needs as follows:1. Mental Health Services: In the current year we continued to focus on ways to address mental and emotional health issues that continue to be a concern in the community and surrounding area. Our providers treat for anxiety, depression, suicidal ideation, substance use disorders, insomnia, ADD, ADHD, and dementia. When patients need further assistance, we place referrals to behavioral health specialists. We offer telemedicine through Rural Psychiatry also. We are working together with Public Health, Law enforcement, and local schools to identify the specific needs for the area concerning mental and emotional health. Providers have implemented certain procedures in their regular clinic visits to let the patient know there are services available. 2. Retaining Young Families: TCMC continues to provide wages and benefits that are comparative or better than other similar facilities to entice college graduates to move to the area. We promote hiring high school students for any job openings we have that they qualify for to hopefully draw an interest to stay in the community and work. TCMC offers job shadowing to the area high school students in any areas of healthcare they are interested in.3. Cost of Healthcare: We continue to provide preventative healthcare procedures and expand healthcare screening to area residents. Outreach professionals continue to bring healthcare to TCMC on a regular basis, allowing patients to stay close to home for the care they need. We will continue to look at ways to expand these services. 4. Childcare: We continue to provide a community daycare as there is a shortage of this service in the area, even though it operates at a loss every year. TCMC daycare is certified Step 4 with the Bright and Early program of North Dakota. Our Director continues to apply for grants to reduce the cost of labor so we are able to continue to provide affordable, high quality daycare in the area. Towner County Medical Center Part V, Section B, Line 16j: The financial assistance policy and application are available on the website and upon request. The financial assistance policy is provided in summary form with the third billing invoice. Towner County Medical Center also has a credit collection policy brochure posted at the clinic reception desk where patients check in. Part V, Line 20d: An application is required to be filled out and on file prior to a patient receiving financial assistance. 1 1 - Towner County Living Center Highway 281 North Box 688 Cando ND 58324 Licensed Nursing Home 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.Part I, Line 7b: The Medicaid cost report was used to calculate the amount of unreimbursed Medicaid.Part I, line 7e and 7f: Costs reported on line 7e and 7f come from the general ledger accounts. Part I, Line 7g: Towner County Medical Center operates the only emergency room in their service area. The cost for subsidizing health services was determined using the Medicare 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 and residents. Part III, Line 3: The methodology for determining the amount of the Organization's implicit price concessions attributable to patients that would be eligible under the Organization's charity care policy was calculated by taking the percentage of individuals below the poverty level times implicit price concessions. 9.8 percent of individuals are below the poverty level and so the organization is estimating that 9.8 percent of implicit price concessions is attributable to individuals eligible for charity care. Part III, Line 4: Footnote from organization's financial statements: The footnote that describes implicit price concessions is found on page 10-11 of the attached audit report. Part III, Line 8: Medicare allowable cost is 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.Hospital services reimbursed on a fee schedule are not included in the Medicare calculation per the 990 instructions. Had this been reported the Hospital would have had a greater loss from Medicare services of $242,956.Medicare fee schedule revenue: $158,913Medicare estimated costs of care relating to payments (401,868)Net (shortage) $(242,956)Towner County Medical Center provides services to patients under the Medicare program knowing they will not recover all the costs associated with providing these services. Providing these services is essential to these patients and the community and increases their access to healthcare services. Therefore, the Medicare shortfall is considered a community benefit. Part III, Line 9b: After a patient receives two statements without making a payment, TCMC will call the patient to discuss their past due account. After the third statement is sent out the patient also receives a written notice saying they are being sent to collections. This notice also provides a number for them to contact TCMC about their past due account. If the patient does get in contact with TCMC they will offer the patient charity care at that time and the patient will need to complete the steps to see if they qualify for charity care. If an individual submits an incomplete financial assistance application, they are contacted regarding the missing information. They are not sent to collections until all of the information has been received and it is determined they do not meet the qualifications for financial assistance. If a person submits a financial assistance application after they have been sent to collections, and it is determined they are eligible for financial assistance, the accounts that qualify will be removed from collections. It is documented on the application submitted if a patient is eligible or ineligible for financial assistance. Part VI, Line 2: A market analysis study had been completed that provided us with the data to strategically plan how to best provide the services that are needed in the communities we serve. We started operations in a new hospital/clinic/nursing home building in June of 2024. The new facility provides updated diagnostic healthcare equipment as well as more modern patient rooms to better accommodate the patient and provide the best care possible. Part VI, Line 3: Towner County Medical Center posts its charity care policy, or a summary thereof, financial assistance application and financial assistance contact information on their website and in admissions areas; includes the policy, or a summary thereof, along with financial assistance contact information in the patient's third billing invoice; and/or discusses with the patient the availability of various government benefits, such as Medicaid or state programs, and assists the patient with qualification for such programs, where applicable. Part VI, Line 4: The community Towner County Medical Center (TCMC) serves is rural with an estimated population of 2,162 people, 25.3% of this is senior population aged 65 and older. The median household income is $52,300 and the average household size is 2.07. Of this population, 9.8% live below the poverty level. There are two hospitals within 40-55 miles of Towner County Medical Center. One is in Rolla, which is within 10 miles from the Turtle Mountain Indian Reservation. The other is in Devils Lake which is within 10 miles from the Spirit Lake Indian Reservation. Part VI, Line 5: Towner County Medical Center's Board of Directors is comprised of volunteers that reside in the community. TCMC would extend medical privileges to all qualified physicians in the hospital to practice, although there are currently no other physicians in the community. Any surplus funds, if available, are used to improve patient care and add additional patient services. The organization built a new hospital/clinic/nursing home which allows them to provide better patient care.TCMC provides specialty cardiac rehab, cancer outpatient services, and operates an emergency room regardless of ability to pay. TCMC is the sole community provider of healthcare services in this community.Community outreach with Public Entities:Towner County was the last county in the state of North Dakota to not have a county public health office. In conjunction with the county, Towner County Medical Center took on the responsibility of starting up the public health office. The program, which is funded by Towner County and through grants, provides many services such as immunizations, baby checks, car seats and other services to those in need. It is through cooperation, such as this, that Towner County Medical Center is able to reach out and provide services to those most in need, who may not otherwise be able to receive these types of preventative services.Community Outreach for the Broader Community:Towner County Medical Center offers a number of services to individuals in the region aimed at providing preventative services, educational services and chronic care management services.TCMC offers its conference room to all members of the community. It can be used for meetings, celebrations, or just as a gathering place to come and socialize.Medical Education - Towner County Medical Center serves as an active participant in the University of North Dakota Medical School training program. Serving as a site for various medical students, we also serve as a clinical site for nurses in training, certified nursing assistant in training, and for other fields in which we have appropriately trained staff and facilities to assist in the training process.Other - We encourage physicians and other staff to be active participants in the community. We have staff actively involved in economic development, in youth sports, in the fine arts, and in community leadership positions. It is through this active partnership that Towner County Medical Center is able to contribute to the community to make it a better place to live and an area that people desire to move to. X X X 0 0 0 0 0 0 0 0 0 Ben Bucher CEO 265487 0 45425 0 0 0 12795 0 27182 0 350889 0 0 0 Grant Lannoye Physician Assistant 197653 0 103623 0 0 0 11258 0 37761 0 350295 0 0 0 Sam Held Family Nurse Practitioner 152212 0 68970 0 0 0 9478 0 37837 0 268497 0 0 0 Tammy Larson CFO 181039 0 29019 0 0 0 9022 0 39259 0 258339 0 0 0 Cassandra Ullyott Family Nurse Practitioner 121954 0 71332 0 0 0 8282 0 35656 0 237224 0 0 0 Jessica Larson Family Nurse Practitioner 131158 0 55159 0 0 0 7403 0 37710 0 231430 0 0 0 Form 990, Part VI, Section A, line 6 The hospital is a membership corporation. The membership is made up of Class A members of the Towner County Hospital Authority. Form 990, Part VI, Section A, line 7a The Board of Directors is elected by the membership at its annual meeting. Form 990, Part VI, Section A, line 7b Amendments to the bylaws by a majority of the Board of Directors must be ratified by the Class A membership at the next succeeding annual meeting. Form 990, Part VI, Section A, line 8b There were no committees with authority to act on behalf of the full board. Form 990, Part VI, Section B, line 11b The CEO will review a draft of the 990. The 990 will be presented to the Board of Directors for their approval prior to filing with the Internal Revenue Service. Form 990, Part VI, Section B, line 12c The CEO, CFO and board members annually disclose any interests that could give rise to conflicts. The CEO reviews the responses. Any member of the Board of Directors having a conflict of interest on any matter should not vote or use his/her personal influence on the matter. The CEO and the CFO do not vote. If they have a conflict of interest they would be asked to leave the room when discussions were held related to the conflict. Any conflict of interest is disclosed and made a matter of record through an annual procedure approved by the Board of Directors. Form 990, Part VI, Section B, line 15a A review and evaluation are performed annually by the Board of Directors and an outside consultant for the CEO. Comparable compensation data are used for compensation and benefits. The CFO's compensation is approved annually by the CEO. 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. Form 990, Part IX, line 11g Contracted Services: Program service expenses 80,402. Management and general expenses 772,600. Fundraising expenses 0. Total expenses 853,002. Other Fees: Program service expenses 2,454. Management and general expenses 85,578. Fundraising expenses 0. Total expenses 88,032. Professional Fees: Program service expenses 1,550,646. Management and general expenses 0. Fundraising expenses 0. Total expenses 1,550,646. Towner County Living Center PO Box 688 Cando ND 58324 450422204 Lease Nursing Home Facility ND 501(c)(3) Line 12b, II Towner County Medical Center Inc 1 Towner County Hospital Authority 228 1st Ave Cando ND 58324 450423303 Lease Hospital Facility ND 501(c)(3) Line 7 N/A 0 0 0 0 0 0 0 0 0 0 0 1 0 0 1 1 0 0 0 0 Towner County Living Center K 32600 General Ledger