North Dakota
North Dakota ambulance providers losing money on every run, according to survey
By: Michael Achterling
FARGO (North Dakota Monitor) – North Dakota ambulance service providers lost nearly $500 on average for every patient transported to a medical facility last year, according to a survey.
The recent survey of three dozen providers in the state, conducted by PWW Advisory Group, was the result of a study created by House Bill 1322 passed during the 2025 legislative session. The group presented the results to the Legislature’s interim Emergency Response Services Committee on Wednesday.
The average revenue generated from an ambulance transport was about $1,100 during 2025, but the expenses were nearly $1,600, said Matt Zavadsky, an EMS and mobile health care consultant with PWW, based in Pennsylvania.
“They are losing money every time they respond to a call,” Zavadsky said during the meeting. “That financial loss has to be made up, typically, by local tax subsidies, fundraisers, bake sales, or all too often, service reductions to try and match expenses with the revenue they can generate.”
He said the problem cannot be fixed by billing reform alone because the revenue generated isn’t enough to fund the cost of readiness, such as personnel, equipment and supplies, among other items.
The survey highlighted 74% of ambulance provider expenses went to personnel costs, but equipment costs have also increased in recent years.
Zavadsky said survey respondents plan to invest about $12.9 million into vehicle and equipment purchases over the next five years, averaging to about $358,000 per provider. However, the cost of a new ambulance has risen to between $275,000 to $480,000 per vehicle. Prior to the COVID-19 pandemic, a new ambulance could cost up to $250,000, he said.
There are more than 100 ambulance service providers in North Dakota. The 36 survey respondents represented a diverse group of providers from city and county services to district-owned, hospital-based and private providers, he said. The average patient transport distance is 34 miles, according to the survey.
Zavadsky said the survey respondents reported 53% of their total revenue was generated from fees for service with the remaining 47% coming from local tax subsidies, state grants and other fundraising.
“What you guys are experiencing in North Dakota and what is happening in the local communities … is not the fault of the local communities, not the fault of the state, this is just our new normal,” Zavadsky said.
Rep. Todd Porter, R-Mandan, owner of Metro-Area Ambulance Service which serves Morton and Burleigh counties, said Medicare patients reimburse ambulance providers at a much lower rate than private insurance and Medicaid patients. He added Medicare patients make up about 60% of the call volume in the Bismarck-Mandan area.
“If we’re being underpaid for 60% of our call volume, then we have to make it up some place,” Porter said.
He said some providers can make up that difference in reimbursement with tax dollars, but not all providers have that option.
“We do other contracted work for nursing homes, hospitals, funeral homes in order to make up that difference,” Porter said. “This is a federal government problem. This is a CMS (Centers for Medicare and Medicaid Services) problem that we’ve known about for years.”
Porter also said ambulance services are not reimbursed for responding to a call with a Medicare patient that doesn’t require a transport to a hospital. According to the survey, about 17% of all ambulance calls don’t require transport to a medical facility.
The survey also showed about 2,300 of the nearly 33,600 patient transports billed last year ended up in collections after being more than 90 days delinquent, totalling $2.7 million, Zavadsky said. The average total of a claim sent to collections was about $1,100.
Zavadsky estimated the total of unpaid claims for more than 100 providers across North Dakota was about $5.8 million in 2025. Some providers don’t have procedures to pursue delinquent billing in collections, he said.
Rep. Jim Grueneich, R-Ellendale, chair of the committee, said the committee will take a deeper look at the data presented on Wednesday and may have recommendations, and possible draft legislation, to address the issue in the 2027 legislative session.
North Dakota
Today in History, 1971: Rugby repeats as North Dakota sand greens golf champion
On this day in 1971, Rugby repeated as North Dakota’s high school sand greens golf champion behind medalist Dwight Stempson’s winning performance.
Here is the complete story as it appeared in the paper that day:
Rugby Repeats As Sand Greens Golf Champion
RUGBY, N. D. — Rugby repeated as North Dakota high school sand greens golf champion here Wednesday, posting a four-man total of 293 strokes for 18 holes.
Led by medalist Dwight Stempson’s medalist 36-35 — 71, the Panthers were eight strokes ahead of runnerup Stanley, which had a 301. Following were Garrison 311, Beulah 315, Leeds 322, Ashley 323, Bottineau 328, Pembina 329, Tioga 332, Parshall 341 and Hettinger 342.
Stempson and teammate Bruce Carlson each had one-under par 71s, but Carlson was unable to be at the regional and wasn’t qualified for individual honors.
Rounding out the Rugby totals were Delwin Wilson 40-37 — 77 and Dennett Hutchinson 35-39 — 74. Gary Kirchoffner, 41-39 — 80, was Rugby’s fifth entrant with the best four-of-five scores counted.
Runnerup Stanley was led by Steve Springan’s 34-38 — 72 and Joe Springan’s 36-38 — 74. Their two-man total of 146 strokes was good enough for the doubles title. Two strokes back with a 148 was the duo of Stempson and Wilson. Stan Saathoff and Mike Stepina of Garrison each had 76s for a 152 total and the Ashley combo of Steve Maier (76) and Dave Kretschmar (78) was fourth with a 154.
Stempson was the driving contest winner with a distance of 280 yards. Chris Knutson of Garrison headed the pitch and putt competition.
Kate Almquist is the social media manager for InForum. After working as an intern, she joined The Forum full time starting in January 2022. Readers can reach her at kalmquist@forumcomm.com.
North Dakota
10 Small Towns In North Dakota Were Ranked Among US Favorites
Walhalla keeps the oldest buildings in North Dakota, fur-trade posts from the 1840s still standing near the Canadian line. Medora sits out in the Badlands, where a French aristocrat tried to build a beef empire in 1883. Garrison fishes one of the largest reservoirs in the country, and Jud has turned nearly every wall in town into a mural. The frontier era left marks across North Dakota that most of the Plains has paved over, and these ten towns still carry them. Each one holds a specific piece of the state’s history and geography.
Garrison
Garrison sits on the north shore of Lake Sakakawea, the reservoir the Garrison Dam holds back on the Missouri River and one of the largest reservoirs in the country. Anglers come year-round for walleye, northern pike, and chinook salmon, and the lake also draws boaters, campers, and shoreline hikers. In town, the open-air Heritage Park Museum preserves a one-room schoolhouse, a railroad depot, a country church, and a homesteader cabin from the turn of the last century. Fort Stevenson State Park, three miles southwest, marks the site of an 1860s military post with an interpretive guardhouse, a marina, a campground, and lakeside trails. Garrison leans into its self-declared title as the Walleye Capital of North Dakota with Wally the Walleye, a 26-foot fiberglass fish on Main Street.
Mayville
Mayville State University anchors this Red River Valley town in Traill County. The public four-year college opened in 1889 as one of the six original state normal schools authorized at North Dakota statehood, and its calendar still drives the town through Comet athletics, theater productions, and the annual Festival of Trees. Island Park, set along the Goose River where it runs through downtown, holds the town’s main recreation space with picnic areas, playgrounds, and a community pool. The volunteer-tended Rainbow Garden along the riverbank mixes themed plantings with folk-art sculptures. The Mayville Water Park runs its pool and slides from Memorial Day through Labor Day.
Lisbon
Lisbon grew up along the Sheyenne River in Ransom County as a Northern Pacific Railroad town, and its 1889 Opera House, now restored and on the National Register, still hosts theater and music. Brick storefronts from the same era line Main Street. Just south of town, the Sheyenne National Grassland protects 70,000 acres of tallgrass prairie, the largest publicly owned tallgrass prairie in the country, with trails open to hikers, riders, and limited hunting. Prairiewood Vineyard, about six miles out, grows cold-climate grapes and pours tastings on weekends.
Fort Ransom
Fewer than 100 people live in Fort Ransom year-round, deep in the wooded Sheyenne River Valley. Fort Ransom State Park preserves the site of an 1867 Army outpost built to guard settlers and the wagon route toward the Black Hills, and it now offers camping, paddling on the Sheyenne, and cross-country skiing. The park’s Sodbuster Days each September run horse-powered farming, threshing, and traditional-craft demonstrations, and the Sheyenne Valley Arts and Crafts Festival fills it over the Fourth of July weekend. The town anchors the Sheyenne River Valley Scenic Byway, a 63-mile route through some of the most varied terrain in the state.
Devils Lake
Devils Lake takes its name from the Dakota “Mni Wak’áŋ,” or Spirit Water, and sits beside the largest natural lake in North Dakota. Between 1993 and 2011, floodwaters more than doubled the lake, swelling it from roughly 70 square miles to over 200 and swallowing roads, farms, and woodland as it rose. Today it holds one of the most productive perch and walleye fisheries in the Upper Midwest. Graham’s Island State Park, on the western shore, is the main access point, with cabins, a campground, a swimming beach, and boat ramps. Fort Totten State Historic Site nearby preserves an 1867 military post with sixteen original buildings restored to tell its story through 1890.
Medora
Medora is the gateway to the south unit of Theodore Roosevelt National Park, set in the Badlands of western North Dakota. The Marquis de Mores, a French aristocrat, founded the town in 1883 and named it for his American wife, Medora von Hoffman; his Chateau de Mores hunting lodge still stands as a state historic site with the family’s original furnishings. The Maltese Cross Cabin, near the park visitor center, is the cabin Theodore Roosevelt used during his 1880s ranching years, the period that shaped his later conservation work. Each summer the Burning Hills Amphitheatre stages the Medora Musical, a Western-themed show running since 1965 in a natural bluff theater over the Badlands. The North Dakota Cowboy Hall of Fame keeps permanent exhibits on ranching, rodeo, and Indigenous horse culture.
Walhalla
Walhalla, founded in 1845 on the banks of the Pembina River, is among the oldest towns in North Dakota. The Kittson Trading Post, built by American Fur Company agent Norman Kittson, stands at the Walhalla State Historic Site and is often called the oldest building in the state; the nearby Gingras Trading Post, the 1840s home and store of Métis trader Antoine Blanc Gingras, holds an equal or older claim. Pembina Gorge State Recreation Area cuts the deepest canyon in North Dakota, carved by the Pembina River, with trails for hiking, biking, and ATVs. Frost Fire Mountain runs downhill skiing and snowboarding in winter and an outdoor theater season in summer.
Valley City
Valley City earns its nickname, the City of Bridges, from the eleven bridges that cross the Sheyenne River and its tributaries within the city limits. The Hi-Line Railroad Bridge, finished in 1908 and listed on the National Register, runs 3,860 feet across the valley and stands 162 feet above the water, one of the longest single-track railroad bridges in the country. The town sits at the eastern end of the 63-mile Sheyenne River Valley Scenic Byway, and Valley City State University, founded in 1890, keeps the local calendar busy with Vikings athletics and the annual Hi-Liner Days festival.
Jud
Jud holds fewer than 100 residents in LaMoure County and is named for Judson LaMoure, an early state legislator. Since the early 2000s, residents and visiting artists have painted murals across nearly every building in town, including the post office, the grain elevator, the fire hall, and several houses, turning the place into a walkable open-air gallery of prairie wildlife, rural scenes, and abstract patterns. The annual Jud Art Festival each summer brings in regional artists and live music. Most travelers come for the murals and the sight of an entire town organized around one creative project.
Bottineau
Bottineau sits a little over ten miles south of the Canadian border as the gateway to the Turtle Mountains. Its mascot, the 30-foot fiberglass Tommy the Turtle, went up in 1978 riding a 34-foot snowmobile and is billed as the world’s tallest turtle statue. Pride Dairy on Main Street is the last small-town creamery still operating in North Dakota, known for its Juneberry ice cream. Lake Metigoshe State Park, about fifteen miles north, offers boating, kayaking, fishing, and winter ice fishing. Bottineau Winter Park, the largest ski area in the state, runs ten runs across 200 vertical feet plus a tubing hill, and Dakota College at Bottineau, established in 1906, anchors the campus side of town.
Where The Frontier Still Shows
What these ten towns share is how much of the frontier they kept. The Missouri River and Lake Sakakawea shaped Garrison. The Sheyenne River Valley runs through Fort Ransom, Lisbon, and Valley City. The Pembina Gorge holds Walhalla on the Canadian border, the Badlands hold Medora, and the Turtle Mountains rise behind Bottineau. Each one still keeps its 19th-century buildings and the kind of small-town institutions that have closed almost everywhere else.
North Dakota
Behind the Badge – Why North Dakota?
Why North Dakota?
District Game Warden Noah Raitz
I admit that when I was first thinking about getting into conservation enforcement, I was not thinking about moving to North Dakota. Not because I didn’t like the state or had a reason not to move here. It was the opposite. I lacked the knowledge of what North Dakota had to offer. I was also in high school, so I had no idea what my plan was other than going to college.
I was just talking about this with another warden and the recruitment of candidates for our game warden positions. Sure, we hire wardens born and raised in North Dakota, but that’s not a requirement for the job. As proof of that, I grew up 30 minutes from the North Dakota border but didn’t start to think of it as an option until college.
I attended the University of North Dakota and one summer I worked for the North Dakota Game and Fish Department as a fisheries seasonal in Devils Lake. I enjoyed the work, but it also showed me the fishing opportunities the state offered that I had never explored before.
I also helped with sharp-tailed grouse surveys in college, which showed me the upland hunting opportunities that, again, I had never explored.
I grew up hunting waterfowl, but not in North Dakota until college, when I was introduced to field hunting. As you can guess, this showed me the prized waterfowl hunting so many people are passionate about in North Dakota.
I say all that because North Dakota’s habitat and natural resources are worth appreciating. It might not be flashy mountains or cabin-packed lakes, but that doesn’t mean we don’t have a lot to offer. We have the prairie, badlands, the Missouri River system, and many other unique landscapes throughout the state.
What do those have in common? They are made up of large areas of undeveloped landscapes for anyone to enjoy. Or in my case, to work in. That’s my office, the habitat for our fisheries and wildlife resources. I may not have a fast-food restaurant or big shopping mall down the road, but I do have various hunting and fishing opportunities within 5 minutes of my house.
I was asked recently what the favorite part of my job is, and it wasn’t very difficult to answer. It’s the interactions I get to have with the public. Getting to listen to a young angler tell me about the big fish they caught, or a new hunter showing off their first duck. It’s also the older generation telling me about hunting or fishing stories from before I was born.
To circle back to where I started, I did not expect to end up in North Dakota, but I am sure glad I did. Enforcing game and fish regulations is easy when the majority of our interactions don’t end in a citation, but instead a hunter or anglers’ story about that day’s success or defeat.
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