Keep your ambulance.

This November, vote to allow us to increase our mill levy.

Increasing the Mill Levy in 2020

On July 22nd, the Board of Directors for our Ambulance District voted to begin the process to place a mill levy increase on the ballot for the November election. This increase would allow the Ambulance District to levy up to 15 mills of a property tax within the District.

We want to provide the voters with as much information to be as educated as possible, and with this information we hope you’ll support us.

Ambulance Service Requirements

Ambulance Services in North Dakota are governed by two sets of rules, the North Dakota Century Code and the North Dakota Administrative Rules.  These rules set the basis for how an ambulance service must function and how it is funded. Click the button to read them all:

Basics of the NDCC and NDAR

  1. The service must be licensed by the Department of Health
  2. It must have two personnel on call at all times
  3. A schedule of on call personnel must be maintained
  4. The ambulance must be enroute to a call within 10 minutes of dispatch
  5. The ambulance must arrive at the scene within 30 minutes.
  6. The ambulance must be equipped as set by the DoH.
  7. The ambulance must have a mobile radio capable of reaching dispatch.
  8. The ambulance must have 2 portable radios capable of reaching dispatch and other responders.

Our Greatest Expenses

Providing qualified responders to meet the above requirements has always been a challenge in Divide County. Up until 2015, the Ambulance District was volunteer. We transitioned to full time staff when it became apparent that the volunteer staffing model was not sustainable. The model is not sustainable for a variety of reasons:

  1. The initial education is often too high for members of the community with families and jobs. A basic EMT course will be over 500 hours alone, with Paramedic being a full time education for a year.
  2. Most employers will not allow their employees to leave during the work day, limiting the amount of responders available to be on call during the day.
  3. The job takes a mental, emotional, and physical toll on you. Without a greater number of responders, many become burned out.
This leaves us without 2 qualified responders, which under North Dakota Century Code is illegal. If a call were to happen and we didn’t respond, we would face the potential of losing our license to operate and subsequently no there would be no ambulance.
For this reason, we pay for staffing. We maintain 4 full time personnel: 2 EMTs and 2 Paramedics. Each person works 4 days on and then receives 10 days off. This however, only covers 1 of the 2 qualified positions.

We continue to rely on volunteer drivers to cover the second position, but when no volunteers are available, we are required to pay full or part time personnel to cover that second position.


Cost Breakdown

Salary: $241,000
Benefits: $45,000
Volunteer Pay: $50,000
Personnel Total: $336,000

The ambulance district does not have a station, and our ambulances, supplies, and equipment reside at St. Luke’s Medical Center.

When we began contracting with Ambulance Resources, we were required by contract to provide housing for their staff. Currently, we maintain an apartment at the Northern Lights Apartments for staff that reside out of the 5 minute response zone of Crosby.

Housing Total: $10,500

Every time we have a patient, we bill their insurance. Medical billing is a complicated process between all of the different insurance companies and billing inappropriately (whether intentional or not) is a common reason for services to be charged in federal courts. We pay a billing company, Metro Ambulance & Billing, $22 per call they bill for us.


Additionally, the North Dakota Tax Commissioner requires we receive a financial audit every year. This audit is done to the Government Accounting Standards. As of 2018, the audit cost was approximately $7,000.


Cost Breakdown

Yearly Audit: $7,000

Billing: $3,500


Management Total: $10,500




We receive income in a few different ways.

  1. The 10 mill levy already in place. This provides most of our operating funds.
  2. Insurance reimbursement.
  3. Grant funding.
  4. Payments for training.

2019 Receipts

  • Levy: 303,580.23
  • Reimbursement: 105,517.49
  • Miscellaneous Revenues: $59,060.72


Total: $468,158.44

Grant Funding

At the end of 2019, we were notified by the Department of Health that although we were eligible for Rural EMS Grant funding, we would not be receiving any. This is a large departure from previous years: in 2016/2017 alone we received $165,000 in grant funding.

We’re not alone, however. Multiple services did not receive grant funding, and even those that did received grant funding only received 79% of their allotted grant amount.

2021 Budget

We have submitted our 2021 budget to the Divide County’s Auditor’s Office. Click the button below to read/download it.

Frequently Asked Questions

  1. The volunteer model is unsustainable. Prior to full time staff, we struggled to maintain qualified personnel.
  2. The education requirements for EMTs and Paramedics are so great that many cannot do EMT school, their full time job, and raise a family.
  3. Many employers no longer allow their employees to leave work. An employee being gone can harm productivity. We’ve had volunteers be threatened with termination for missing work due to ambulance calls.

The volunteer model hasn’t just become unsustainable, it’s been this way for years.

In 2018 we moved from a staffing company to employees ran by us. A few reasons we switched:

  1. The staffing company doing un-authorized business as the Ambulance District, specifically reporting other healthcare facilities to state regulators without Board knowledge.
  2. An inability to work with others. Complaints of attitude and arrogance popped up more than once when it came to the providers.


We recognize cost was not one of those factors at that time. There are reasons we believe keeping the ambulance district local is important:

  1. Cost – in 2017 we paid $450,000 for staffing alone. This did not include pay for volunteer responders (who receive stipends), housing costs for the contracted staff, medical supplies, fuel, maintenance, or any other cost. Yes, we remained in the black at that time, however it was a different time. Since then, ambulance calls have decreased 59% and grant money is no longer being awarded. In 2017 we had our highest grant award, our highest amount of calls billed, and the mill levy. In that situation, it would be hard for anyone to not be able to make and save money in that situation.
  2. Transparency – when an employee is hired by the Ambulance District and not a private company, they’re an employee of a political subdivision and subsequently accountable to the taxpayers. As an example, if John Doe is a Paramedic for our Ambulance District and is fired for cause – let’s say suspicion of narcotics diversion, that is public information. You have a right to know that information. You also have a right to any communication between employees (wiuth very limited exceptions), a right you don’t get with a private company.
  3. Economic benefits – by keeping your staff as members of the district, you’re hiring local employees. Those employees live here, spend their money here, and pay taxes here. It helps the local economy. With a staffing company, employees may come from anywhere in the US and only be here for work.
  4. Caring – When you have local employees who live here or have grown up here, they’re invested in the community and you. They will treat you like family.

Yes, and we have! We have “trimmed the fat” so to speak – we have a lean budget that’s mostly taken up by personnel costs. Here’s a few measures we’ve taken:

  • In 2019, eliminated 2 full time positions, saving over $100,000.
  • Join the Savvik buying group, lowering prices for medical supplies, oxygen, and other equipment.
  • Instituted greater limitations on supplies employees may purchase without supervisor approval.
  • Decreased training costs by holding training locally with local instructors.
  • Sold no longer used equipment – for example, our IV pumps that were losing manufacturer support.

Please do!

We encourage residents and taxpayers to come to our meetings – the next is September 16th at 6pm, and is hosted at the Divide County Courthouse.

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