2026-04-01T18:33:43-05:00 2025-06-30 450250958 Eide Bailly LLP 4585 Coleman St Ste 200 Bismarck ND 58503 990 2024-07-01 450447670 Mountrail County Medical Center MOUN 7016282424 615 6th Street SE Stanley ND 58784 Eugeniya Griffin CFO 7016282424 2026-03-27 1 1 Lisa Chaffee CPA P00193453 7012551091 2026-03-23 2024 2025-03-06 01:10:19Z Stephanie Everett 615 6th Street SE Stanley ND 58784 13136527 0 X www.stanleyhealth.org X 1997 ND Provision of medical services to the residents of Stanley, ND. 6 6 9 7 0 0 245929 487439 10008924 12406932 192384 171354 23543 20595 10470780 13086320 0 0 0 0 1095710 995700 0 0 0 9398823 10174178 10494533 11169878 -23753 1916442 12859032 15078247 2501940 2804713 10357092 12273534 X At Mountrail County Health Center we strive to create an environment which encourages all individuals to attain their highest level of physical, emotional, and spiritual health.We will achieve this environment by adhering to the words of our core values. Our core values are: honesty, excellence, accountability, respect, and teamwork. 0 0 9326043 12406932 Mountrail County Medical Center is an 11-bed critical access hospital and clinic which promotes the health of the community by providing a variety of health services.Mountrail County Medical Center has taken steps to enhance preventative care for people of all ages through the development of guidelines to ensure that those who come here for preventative care receive the screenings and recommendations appropriate to their personal and family history. The hospital provided 117 inpatient days, 626 swing bed days, and 1,448 observation hours during the fiscal year 2025. Statement continued on Schedule O.Mountrail County Medical Center had 116 admissions (43 acute, 27 swing bed, 46 observations), and 3,178 emergency visits.The Medical Center provides healthcare services to patients who meet certain criteria under its charity care policy without charge or at amounts less than established rates. Since the Medical Center does not pursue collection of these amounts, they are not reported as patient service revenue. The estimated cost of providing these services was $34,000 for the year ended June 30, 2025, calculated by multiplying the ratio of cost to gross charges for the Medical Center by the gross uncompensated charges associated with providing charity care to its patients. 9326043 1 1 0 0 0 0 0 0 0 0 1 0 0 0 1 1 1 0 0 0 0 0 0 0 0 0 1 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 16 0 1 9 1 0 0 0 0 0 0 0 0 0 0 0 0 X 6 6 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 0 0 X Eugeniya Griffin 7016288645 PO Box 399 Stanley ND 58784 X Ryan Gjellstad President 1.00 X X 0 0 0 Michael Sorenson Vice President 1.00 X X 0 0 0 John Anderson Secretary/Treasurer 1.00 X X 0 0 0 Debra Boppre Director as of Aug '24 1.00 X 0 0 0 Jamie Germundson Director as of Dec '24 1.00 X 0 0 0 Elliot Leinen Director as of Jan '25 1.00 X 0 0 0 Marlin Ranum Director until Nov '24 1.00 X 0 0 0 Julie Passaglia Director until Aug '24 1.00 X 0 0 0 Stephanie Everett CEO/Administrator 20.00 X 230017 0 38011 Eugeniya Griffin CFO 20.00 X 87598 0 3497 Mark Longmuir MD Family Medicine/Chief of Staff 40.00 X 310496 0 42731 Jessica Charon DNP FNP-C Doctor of Nursing Practice 45.00 X 209176 0 8111 Tara Nardacci DNP Family Nurse Practitioner 43.00 X 174425 0 38193 Abbey Ruland PA Physician Assistant 40.00 X 152130 0 38664 Tammie Braaflat FNP-C Family Nurse Practitioner 40.00 X 151045 0 34190 Brittany Haugtvedt Family Nurse Practitioner 40.00 X 140215 0 5583 1455102 0 208980 6 0 0 1 Mountrail Bethel Home Inc PO Box 700 Stanley ND 58784 Purchased services 5165000 Fiber Staffing 3811 Turtle Creek Blvd Suite 850 Dallas TX 75219 Medical staffing services 547615 McGough Contstruction Co LLC 2737 Fairview Ave N St Paul MN 55113 Construction management 284938 Homestead Recruiters Inc 821 Senior Ave Dickinson ND 58601 Medical staffing services 244726 EAPC 3100 Demers Ave Grand Forks ND 58201 Engineering firm 193198 9 35929 451510 487439 Patient Service Revenue 621400 10490167 10490167 Pharmacy Revenue 621400 1314275 1314275 Sales Tax Revenue 900099 485170 485170 117320 117320 12406932 198013 198013 44143 23548 20595 20595 20595 26659 -26659 -26659 -26659 13086320 12406932 0 191949 X 360233 360233 447905 447905 40211 40211 54667 54667 92684 92684 63875 63875 72955 72955 7050686 5708614 1342072 34992 34992 81010 81010 60200 7991 52209 535396 535396 21494 5428 16066 13201 12107 1094 395717 361482 34235 90352 90352 Medical Supplies 1583971 1583971 Equipment Rental 92730 91663 1067 Employee Education 42406 23691 18715 35193 35193 11169878 9326043 1843835 0 519 519 5736657 6773139 1364465 2261640 90401 83006 135421 119779 10282027 4843805 4341289 5438222 1190280 401942 12859032 15078247 322342 736920 1147766 1082736 1031832 985057 2501940 2804713 X 10253405 12116034 103687 157500 10357092 12273534 12859032 15078247 1916442 0 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 25000 25000 382294 149149 233145 4400781 2206039 2194742 3442242 2488617 953625 2031710 2031710 5438222 Trinity Health Payable 166752 Operating Lease Liabilities 327254 Construction Payable 452051 Estimated Third-Party Payor Settlement 39000 985057 X 13109868 0 13109868 -23548 -23548 13086320 11193426 23548 23548 11169878 0 11169878 Part X, Line 2: The Medical Center believes that it has appropriate support for any tax position taken affecting its annual filing requirements, 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 benefits and liabilities in income tax expense if such interest and penalties are incurred. Part XI, Line 4b - Other Adjustments: Rental Expenses included in revenue for Form 990 -23,548. Part XII, Line 2d - Other Adjustments: Rental expenses included in revenue for Form 990 23,548. 1 1 X 1 X 0 1 1 0 0 34000 34000 0.00300 445792 376949 68843 0.00620 479792 376949 102843 0.00920 1477837 1460207 17630 0.00160 1477837 1460207 17630 0.00160 1957629 1837156 120473 0.01080 1 1276462 319116 2609630 2623694 -14064 X 1 1 1 1 Mountrail County Medical Center 615 6th Street SE Stanley ND 58784 www.stanleyhealth.org 5047 X X X X Provider based rural health clinic Mountrail County Medical Center 1 0 0 1 X X X X X X X X X 24 1 0 0 1 X www.stanleyhealth.org/resources X 1 24 1 www.stanleyhealth.org/resources 0 1 X 200.000000000000 0.000000000000 X X X X 1 1 X X X 1 X www.stanleyhealth.org/resources X www.stanleyhealth.org/resources X www.stanleyhealth.org/resources X X X X X X 1 X 0 X X X X 1 X 0 0 Mountrail County Medical Center Part V, Section B, Line 5: A community group, consisting of eight community members, was convened and first met on December 5, 2024. During this first community group meeting, group members were introduced to the needs assessment process, reviewed basic demographics information about the community, and served as a focus group. Focus group topics included community assets and challenges, the general health needs of the community, community concerns, and suggestions for improving the community's health. The community group met again on February 21, 2025, with nine community members in attendance. At this second meeting, the community group was presented with survey results, fundings from key informant interviews and the focus group, and a wide range of secondary data, relating to the general health of the population in Mountrail County. The group was then tasked with identifying and prioritizing the community's health needs. Members of the community group represented the broad interests of the community served by Mountrail County Medical Center (MCMC) and the Upper Missouri District Health Unit (UMDHU).A one-on-one interview with one key informant was conducted in person in Stanley on December 5, 2024. Two additional key informant interviews were conducted over the phone in December of 2024. A representative from CRH conducted the interviews. Interviews were held with selected members of the community who could provide insights into the community's health needs. Included among the informants were public health professionals with special knowledge in public health, acquired through several years of direct experience in the community, including working with medically underserved, low income, and minority populations, as well as with populations with chronic diseases. A survey was distributed to solicit feedback from the community and was not intended to be a scientific or statistically valid sampling of the population. It was designed to be an additional tool for collecting qualitative data from the community at large specifically, information related to community-perceived health needs. Mountrail County Medical Center Part V, Section B, Line 11: The most recent community health needs assessment (CHNA) was completed during fiscal year 2025. The top needs facing the community were: Adult alcohol use and abuse (combined with youth); availability of resources to help the elderly stay in their homes; extra appointment hours, such as evening and weekends; having enough child daycare services; youth drug use and abuse (combined with adult). Extra appointment hours, such as evenings and weekends: At this time, we cannot address this item for we are in the process of a four-year building project. We do not have the room or the staff capability now. We will revisit this issue when our building project is complete at the end of 2027. Mountrail County Medical Center has not been able to address the need of having enough child daycare services. In the near future, we are planning on working with the Raggamuffins Childcare Learning Center, which will be opening a brand new building, allowing more children to be taken care of. Adult and Youth alcohol use and abuse: We have compiled a brochure that shows all the services that can help patients with this disorder who leave our ER. We work closely with the Upper Missouri District Health Unit (UMDHU) and their addiction counselor. We also work closely with Stanley's local AA group.Availability of resources to help the elderly stay in their homes: Mountrail County, in conjunction with the Mountrail County Medical center, is working on a feasibility study with Eide Bailley to see the needs in the entire county on this subject. Our rural health clinic is actively looking into wearable health devices for our patients. Mountrail County Medical Center is currently participating in a Cohort with the Center for Rural Health focusing on building a strong Chronic Care Management (CCM) program. We have started introducing patients to the CCM program. The Medical Center addressed the needs from the 2021 CHNA during fiscal year 2025.Alcohol use and abuse for all ages: This need is carred to the 2024 CHNA and is still something we are still trying to address. Depression/anxiety: MCMC continues to offer Clinical Social Work and psychiatric services in the clinic. With the added behavioral health bolt to our Avel services in the ER department, our providers continue to receive help in identifying mental health behaviors. Attracting and retaining young families: While MCMC has long recognized the importance of community growth, we have not been able to fully address the challenge of attracting and retaining young families in the area. Despite being one of the region's largest employers, recruiting employees with young families has been difficult due to the limited resources available locally. These gaps were identified in the most recent CNHA, and we hope to begin addressing them in the near future. Childcare need: after reviewing spaces for this in our buildings or offsite, we determined that this issue cannot be addressed by the Mountrail County Medical Center. We will not have available space on site. Mountrail County Medical Center Part V, Section B, Line 13h: The Medical Center does not provide discounted care.The following factors will also be considered in determining the eligibility for financial assistance:1. Proof of Income (to include one or more of the following):a. Adjusted Gross Income if self-employed and all schedules from the most current tax formb. Employment status and future earning capacity2. Number of Dependents3. Other financial obligations Mountrail County Medical Center Part V, Section B, Line 16j: In correspondence sent to patients it is encouraged to inquire about the financial assistance policy. Part I, Line 3c: The Medical Center does not provide discounted care.The following factors will also be considered in determining the eligibility for financial assistance:1. Proof of Income (to include one or more of the following):a. Adjusted Gross Income if self-employed and all schedules from the most current tax formb. Employment status and future earning capacity2. Number of Dependents3. Other financial obligations 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. Unreimbursed Medicaid on line 7b was calculated using the costing methods to prepare the cost report. The cost for subsidized health services reported on line 7g was determined using the Medicare Cost Report. Part III, Line 2: The amount 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: Approximately 25% of the Hospital's implicit price concession is attributable to patients eligible under the Organization's financial assistance policy. This is the approximate percentage of applications denied or not returned due to insufficient information. Part III, Line 4: The footnote to the Organization's financial statements can be found on pages 9-10 of the attached audited financial statements. Part III, Line 8: Mountrail County Medical Center is a critical access hospital providing Medicare services to patients knowing they will not recover all the costs associated with providing these services. Providing these services is essential to these patients therefore the Medicare shortfall is considered a community benefit. Both the total revenue received from Medicare and the Medicare allowable costs are reported from the Medicare Cost Report. The Medicare Cost Report is completed based on the rules and regulations set forth by the Centers for Medicare and Medicaid Services.Hospital services rendered on a fee schedule are not included in the Medicare calculations per the 990 instructions. Had this been reported the Hospital would have had a greater loss from Medicare services of $56,775.Medicare fee schedule revenue $41,888Medicare estimated costs of care relating to payments $98,663Net (shortage) $(56,775) Part III, Line 9b: While a financial assistance application is pending final eligibility determination, Mountrail County Medical Center will not initiate collection efforts or requests for deposits, provided the responsible party is cooperative with Mountrail County Medical Center's efforts to reach a determination. The financial assistance approval can be extended up to a maximum of six months from the approval date to cover future qualified care or services and will consider balances on services which occurred within the last 240 days only. If a portion of an account is written off to charity care, any personal portion due follows the same collection procedures as other accounts. Part VI, Line 2: The Medical Center continues to access the health needs of the community by involvement in community organizations and physicians seeing patients on a daily basis. Part VI, Line 3: Mountrail County Medical Center has conspicuous public displays that notify and inform patients about the financial assistance program. Such displays are located in the emergency room and all admissions areas. Such displays include the following information:a. A statement that Mountrail County Medical Center offers financial assistance to eligible individuals. b. Information about how or where to obtain information about the Mountrail County Medical Center Financial Assistance Policy and application process. Mountrail County Medical Center will offer a paper copy of the Plain Language Summary of this Financial Assistance Policy to patients as part of the intake and/or discharge process.Mountrail County Medical Center will include the following information on all billing statements:a. Financial assistance is available under the Mountrail County Medical Center Financial Assistance Policy.b. The telephone number of a Mountrail County Medical Center office or department that can provide information about the Mountrail County Medical Center Financial Assistance Policy and process.c. The direct website address (http://www.stanleyhealth.org/resources) on which this Mountrail County Medical Center Financial Assistance Policy, a Plain Language Summary of this policy, and the Financial Assistance Application are available.Paper copies of this Financial Assistance Policy, a Plain Language Summary, and the Financial Assistance Application are available upon request and without charge. These paper copies are available by mail, in Mountrail County Medical Center's emergency room, and all other admissions areas of Mountrail County Medical Center. Part VI, Line 4: Mountrail County Medical Center is a critical access hospital located in northwest North Dakota, approximately 60 miles west of Minot. The city is mainly dependent on agriculture and oil as sources of economic stability. With nearly 140 employees, MCMC/MBH is one of the largest employers in Stanley. As of 2023, the population of Stanley was 2,214 with the county population being 9,507. The estimated median Stanley household income in 2023 was $109,573. The Mountrail County unemployment rate in 2023 was 1.1% compared to 1.9% in the state of North Dakota. The percentage of county residents with income below the poverty level in 2023 was 8.4%. Part VI, Line 5: Mountrail County Medical Center is an 11-bed critical access hospital with an emergency room and provider based rural health clinic. MCMC provides comprehensive medical care with physician and mid-level medical providers and consulting/visiting medical providers. MCMC has one Physician, two Physician Assistants, five Family Nurse Practitioner, and 16 nurses for a combined total of 24 healthcare providers. The board members are not employees nor independent contractors of the Hospital. Surplus funds are used for infrastructure and equipment upgrades.Mountrail County Medical Center is the community's sole provider and has an emergency room available 24/7 to all regardless of their ability to pay. 0 0 0 0 0 0 0 0 0 Mark Longmuir MD Family Medicine/Chief of Staff 305351 0 4557 0 588 0 12086 0 30645 0 353227 0 0 0 Stephanie Everett CEO/Administrator 227878 0 1000 0 1139 0 9419 0 28592 0 268028 0 0 0 Jessica Charon DNP FNP-C Doctor of Nursing Practice 209061 0 0 0 115 0 8111 0 0 0 217287 0 0 0 Tara Nardacci DNP Family Nurse Practitioner 174288 0 0 0 137 0 7548 0 30645 0 212618 0 0 0 Abbey Ruland PA Physician Assistant 140528 0 11358 0 244 0 5936 0 32728 0 190794 0 0 0 Tammie Braaflat FNP-C Family Nurse Practitioner 141619 0 9028 0 398 0 5894 0 28296 0 185235 0 0 0 Form 990, Schedule J, Part II: Stephanie Everett, CEO/Administrator, is compensated by Mountrail Bethel Home, an unrelated organization, for services to Mountrail County Medical Center and Mountrail County Bethel Home. Compensation shown on Part VII of the 990 is calendar year 2024 compensation that was paid by Mountrail Bethel Home. Eugeniya Griffin, CFO, is compensated by Mountrail Bethel Home, an unrelated organization, for services to Mountrail County Medical Center and Mountrail County Bethel Home. Compensation shown on Part VII of the 990 is calendar year 2024 compensation that was paid by Mountrail Bethel Home. Form 990, Part VI, Section A, line 1a The Board of Directors may designate three of its members (one Bethel appointee, one Trinity appointee, and one community representative) as an Executive Committee, which, to the extent determined by the board and permitted by law shall have and exercise the authority of the board in the management of the business of the corporation. The Executive Committee shall act only in the intervals between meetings of the board and shall at all times be subject to the control and direction of the board. A majority of the Executive Committee shall constitute a quorum for the transaction of any business. Form 990, Part VI, Section A, line 6 Mountrail Bethel Home, Inc. and Trinity Health are the sole members of this corporation. The Board of Directors may not terminate, modify, or in any way curtail the membership rights of Mountrail Bethel Home, Inc. or Trinity Health. Form 990, Part VI, Section A, line 7a The Members, Mountrail Bethel Home and Trinity Health Center, have the power to appoint the Board of Directors and remove any director at any time. Bethel Home and Trinity each appoint two directors to the board. The four designated board members appoint two members from the service area of Mountrail County Medical Center. Form 990, Part VI, Section A, line 7b The following items are member reserved powers: A. The right to approve any amendments to the articles of incorporation or the bylaws. B. The right to approve the selection of auditors and legal counsel. C. The right to approve any budgets or strategic plans adopted. D. The right to approve any unbudgeted borrowing, any encumbrance of assets, and any expenditures for capital improvements where the amount exceeds 5% of the capital budget previously approved by the member. E. The right to change the number of directors of the board of directors. F. The right to approve any action of the corporation that is not in the ordinary course of the corporation's business. G. The right to dissolve or discontinue the operations of the corporation. The board is to promptly inform the member in writing of the board's intent to take any action over which the member has the right to approval. No such action shall become final or binding on the corporation until such time as the member has given the board its written approval of the action. The member must indicate its approval or disapproval in writing within thirty days of its receipt of such a notice. Form 990, Part VI, Section B, line 11b The governing body receives a copy of the 990 by email prior to the 990 being filed. The 990 is reviewed by the CFO and CEO. Form 990, Part VI, Section B, line 12c The board members and officers sign a conflict of interest policy annually. The board members and officers are responsible for bringing up potential conflicts of interest. Board members will abstain from voting on issues where there might be a conflict. Form 990, Part VI, Section B, line 15a The CEO/Administrator and CFO are compensated by Mountrail Bethel Home, an unrelated organization. The CEO/Administrator and CFO perform services for both Mountrail Bethel Home and Mountrail County Medical Center. Mountrail Bethel Home determines compensation for both positions. The CEO/Administrator's compensation is reviewed and approved by the Board of Directors on an annual basis. The internal salary review is based on the salary survey from NDLTC Association. The last salary review was completed September 2024. The determination of compensation is documented in the board minutes and personnel file. The CFO's compensation is reviewed and approved by the CEO/Administrator on an annual basis. The internal salary review is based on the salary survey from NDLTC Association. The last salary review was completed September 2024. The determination of compensation is documented in the personnel file. The key employee's compensation is reviewed and approved by the Board of Directors on an annual basis. The internal salary review is based on the Gallagher survey and was last completed in December 2023. The determination of compensation is documented in the personnel file. Form 990, Part VI, Section C, line 19 The Organization's governing documents, conflict of interest policy and financial statements are available to the public upon request. Form 990, Part VII: The compensation reported in Part VII for the CEO/Administrator and CFO is total compensation for services provided to Mountrail County Medical Center and Mountrail Bethel Home. Mountrail Bethel Home is not considered a related organization, therefore hours for services to Bethel Home are not included on Part VII. Form 990, Part IX, line 11g Purchased Services: Program service expenses 4,557,758. Management and general expenses 1,220,386. Fundraising expenses 0. Total expenses 5,778,144. Collection Fees: Program service expenses 8,473. Management and general expenses 66,693. Fundraising expenses 0. Total expenses 75,166. Outside Fees: Program service expenses 207,082. Management and general expenses 0. Fundraising expenses 0. Total expenses 207,082. Professional Fees: Program service expenses 0. Management and general expenses 46,134. Fundraising expenses 0. Total expenses 46,134. Contracted Services: Program service expenses 935,301. Management and general expenses 8,859. Fundraising expenses 0. Total expenses 944,160.