NCAD 2-10-21

Judy Martin, CPA with Harden, Cummings, Moss & Miller, discusses the 2019 audit with the Nodaway County Ambulance District Board of Directors during a Feb. 10 meeting at district headquarters. She discussed the need for more segregation of duties with regard to district funding, but that it also is a very regular occurrence with small staffs.

MARYVILLE, Mo. — The Nodaway County Ambulance District approved the purchase of a new 53-inch ram for the Maryville rescue truck at its Feb. 10 meeting held at district headquarters.

Board member Phil Rickabaugh brought up the need at the January meeting after an old extrication set was gifted to the Tri-C rescue squad. The district did that when new tools (not including a ram) were purchased for Unit 136.

NCAD Director of Operations Bill Florea said he believed the board had intended to purchase a new ram after it purchased new HURST eDRAULIC extrication tools in early 2019.

Rickabaugh brought quotes from Sentinel Emergency Solutions and Alex Air for two different rams that would work with current batteries and equipment to board members. The first option is a 53-inch HURST ram, the kicker plate and two batteries. The second option was for a 59-inch ram, a kicker plate and two batteries.

The quote from Alex Air was $7,210 for 53-inch and $7,400 for the 59-inch. The quote from Sentinel was $6,859.34 for the 53-inch and $7,038 for the 59-inch.

After some discussion regarding its need within the district and how often it might be used, the board approved the district to purchase the 53-inch RAM from Sentinel.

“It’s a nice tool to have in our tool box,” Rickabaugh said.

In 2019, he told the board much the same, that it wasn’t a necessity, “but it’s nice to have in the tool box.”

GEMT payment

Business Manager LaRee Lager said the Missouri GEMT (Ground Emergency Medical Transportation) payment is nearing, sometime in April.

She said after completing the arduous task of filling out all the necessary forms reporting the district’s transportation costs for the past year, the district is set to receive around $133,302.32.

Missouri GEMT is a funding program that helps rural ambulance districts recover uncompensated costs. The federal program was created over three years by Missouri fire chiefs and the state of Missouri. It will provide additional funding based on cost reporting from the district.

One of the requirements of the program is that NCAD is responsible each year to send in 30 percent of the total payment to the program of which 12 percent is sent to the state.

“This is the dumbest damn thing I’ve ever heard of in my life,” said board president Herb Snodderley.

The district joined the funding program in June 2018, as a way to help cover the gap between the actual cost of ambulance transports and the allowable amount received from Medicaid.

At last week’s meeting Lager gave an example that the actual cost of an ambulance ride is somewhere between $2,500 and $3,500. Medicaid only pays around $104 for a BLS call or $389 for an ALS call and $5 per mile. If a bill is $1,000, the district is typically only reimbursed around $500.

In 2018, then board member Julia Crady asked if the district could ever lose money being a part of this program. Lager said “No.”


Judy Martin, CPA with Harden, Cummings, Moss & Miller, discussed the 2019 audit with board members.

“It was a real challenge this year,” she told them.

Because the district office has been closed to the public, the audit was completed off site, with files being delivered. But she was thankful the district was so accommodating to them.

“It’s late,” Martin said. “We realize it’s late. There was just no way around it.”

Findings in the audit included the need for more segregation of duties. She noted that one person has access to all district funds, but with the district’s small staff size, it becomes a regular occurrence in audits.

Other news

  • A CD was cashed in and left in a district Money Market account to cover the upcoming GEMT payment, according to board treasurer Carrie Sparks. She noted the interest is very low.
  • Board member Patricia Giesken was asked by Ravenwood Rescue Squad member Bryan Sobotka about the possibility of adding a budget line for rescue squads for equipment and maintenance. Giesken suggested all squads put together a list of items that would be useful and present it to the board.
  • Florea told the board, more investigation into the current plan for new construction found more difficulties with regard to location. The new build would extend about 1-foot into the detention pond and the basement level of the new building would be lower than the drain. The board discussed lowering the drain and pipe to the street, changing location of the building and possibly renovating the north bay to include four bedrooms and a restroom. Florea said he would discuss the drainage situation with Brock Pfost, who did the original drainage work.
  • The district received a $9,000 grant from the Nodaway County Senior Board for PAT van expenses and the Knights for transportation costs.
  • Board members approved a change to its bylaws to include the associate director be added to allowable signatures.
  • The board discussed the addition of an extra paid holiday. Snodderley wanted to know how much that additional day would cost the district. Discussion became confused when Florea began talking about the separation of sick and vacation time, a different topic entirely. Once the topics were clarified, board members didn’t seem to want to discuss sick vs. paid time off and would like it to stay as it is, separate. Florea said he would provide a cost impact statement at next month’s meeting.
  • The board approved Medicare/Medicaid adjustments in the amount of $7,917.44. It also approved sending $14,099.28 worth of billing to collections.
  • After a brief closed session the board approved a longevity bonus of $540 and a performance incentive of $450 to Lager.