North Dakota Code § 6-09-47

Medical facility infrastructure loan fund - Medical facility infrastructure loan
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program - Rural health loan program - Medical facility emergency operating loan 
program - Continuing appropriation - Audit and costs of administration. (Effective 
through June 30, 2027)
1. The Bank of North Dakota shall administer a medical facility infrastructure loan 
program to provide loans to medical facilities to conduct construction that improves the 
health care infrastructure in the state or improves access to existing nonprofit health 
care providers in the state. The construction project may include land purchases and 
may include purchase, lease, erection, or improvement of any structure or facility to 

the extent the governing board of the health care facility has the authority to authorize 
such activity.
2. In order to be eligible under the medical facility infrastructure loan program, the 
applicant must be the governing board of the health care facility which shall submit an 
application to the Bank. The application must:
a. Detail the proposed construction project, which must be a project of at least 
one million dollars and which is expected to be utilized for at least thirty years;
b. Demonstrate the need and long-term viability of the construction project; and
c. Include financial information as the Bank may determine appropriate to determine 
eligibility, such as whether there are alternative financing methods.
3. A medical facility infrastructure loan provided under this section:
a. May not exceed the lesser of fifteen million dollars or seventy -five percent of the 
actual cost of the project;
b. Must have an interest rate equal to two percent; and
c. Must provide a repayment schedule of no longer than twenty-five years.
4. A recipient of a medical facility infrastructure loan under this section shall complete the 
financed construction project within twenty-four months of approval of the loan. Failure 
to comply with this subsection may result in forfeiture of the entire loan received under 
this section.
5. The Bank shall administer a rural health loan program to provide short-term gap 
financing to grant recipients under the federal rural health transformation program with 
approved projects and a demonstrated financial need.
a. To be eligible for a rural health loan under this subsection, the applicant:
(1) Must be approved for a grant by the department of health and human 
services and the centers for Medicare and Medicaid services, as applicable, 
under the federal rural health transformation program based on policies 
developed by the department of health and human services.
(2) Provide information as requested by the Bank, including information 
substantiating a demonstrated financial need and evidence of project 
approval from the department of health and human services under the 
federal rural health transformation program.
b. A loan under this subsection must have:
(1) An annual interest rate that does not exceed two percent;
(2) A term that complies with the criteria established by the department of 
health and human services, in accordance with the federal rural health 
transformation program, and does not exceed three years.
c. From the repayment of loans under this subsection, the principal portion must be 
used to replenish the Bank's profits which were transferred to the fund for the 
loans under this program, and interest portion must be deposited in the fund.
6. The Bank shall administer a medical facility emergency operating loan program to 
provide emergency operating loans to local nonprofit hospitals located in cities with a 
population of fewer than two thousand five hundred according to the most recent 
decennial census.
a. To be eligible for an emergency operating loan under this subsection, the 
governing board of a health care facility shall:
(1) Submit an application to the Bank by March 31, 2026;
(2) Provide financial information as requested by the Bank to determine 
eligibility, including information on alternative financing and other funding 
sources; and
(3) Provide an updated operating plan and cash flow projections indicating the 
feasibility of future operations after restructuring and sufficient financial 
resources to address any operating deficit and to repay the loan.
b. A medical facility emergency operating loan under this subsection:
(1) May not exceed five million dollars per qualified applicant;
(2) Must have an annual interest rate that does not exceed two percent; and

(3) Must have a maximum term that does not exceed eleven years, unless a 
shorter term is required based on an analysis by the Bank, with the first year 
of the loan eligible for interest-only payments.
7. The medical facility infrastructure loan fund is a special fund in the state treasury. This 
fund is a revolving fund. All moneys transferred into the fund, interest on moneys in the 
fund, and collections of principal and interest on loans from the fund are appropriated 
to the Bank on a continuing basis for the purpose of providing loans under this section.
8. Moneys in the fund may be used for loans as provided under this section and to pay 
the costs of administration of the fund. Annually, the Bank may deduct a service fee for 
administering the fund.
9. The fund must be audited in accordance with section 6 -09-29. The cost of the audit 
and any other actual costs incurred by the Bank on behalf of the fund must be paid 
from the fund.
10. The Bank shall deposit medical facility infrastructure loan repayments in the fund.
Medical facility infrastructure loan fund - Medical facility infrastructure loan program - 
Rural health loan program - Continuing appropriation - Audit and costs of administration. 
(Effective after June 30, 2027)
1. The Bank of North Dakota shall administer a medical facility infrastructure loan 
program to provide loans to medical facilities to conduct construction that improves the 
health care infrastructure in the state or improves access to existing nonprofit health 
care providers in the state. The construction project may include land purchases and 
may include purchase, lease, erection, or improvement of any structure or facility to 
the extent the governing board of the health care facility has the authority to authorize 
such activity.
2. In order to be eligible under the medical facility infrastructure loan program, the 
applicant must be the governing board of the health care facility which shall submit an 
application to the Bank. The application must:
a. Detail the proposed construction project, which must be a project of at least one 
million dollars and which is expected to be utilized for at least thirty years;
b. Demonstrate the need and long-term viability of the construction project; and
c. Include financial information as the Bank may determine appropriate to determine 
eligibility, such as whether there are alternative financing methods.
3. A medical facility infrastructure loan provided under this section:
a. May not exceed the lesser of fifteen million dollars or seventy -five percent of the 
actual cost of the project;
b. Must have an interest rate equal to two percent; and
c. Must provide a repayment schedule of no longer than twenty-five years.
4. A recipient of a medical facility infrastructure loan under this section shall complete the 
financed construction project within twenty-four months of approval of the loan. Failure 
to comply with this subsection may result in forfeiture of the entire loan received under 
this section.
5. The Bank shall administer a rural health loan program to provide short-term gap 
financing to grant recipients under the federal rural health transformation program with 
approved projects and a demonstrated financial need.
a. To be eligible for a rural health loan under this subsection, the applicant:
(1) Must be approved for a grant by the department of health and human 
services and the centers for Medicare and Medicaid services, as applicable, 
under the federal rural health transformation program based on policies 
developed by the department of health and human services.
(2) Provide information as requested by the Bank, including information 
substantiating a demonstrated financial need and evidence of project 
approval from the department of health and human services under the 
federal rural health transformation program.
b. A loan under this subsection must have:
(1) An annual interest rate that does not exceed two percent;

(2) A term that complies with the criteria established by the department of 
health and human services, in accordance with the federal rural health 
transformation program, and does not exceed three years.
c. From the repayment of loans under this subsection, the principal portion must be 
used to replenish the Bank's profits which were transferred to the fund for the 
loans under this program, and interest portion must be deposited in the fund.
6. The medical facility infrastructure loan fund is a special fund in the state treasury. This 
fund is a revolving fund. All moneys transferred into the fund, interest on moneys in the 
fund, and collections of principal and interest on loans from the fund are appropriated 
to the Bank on a continuing basis for the purpose of providing loans under this section.
7. Moneys in the fund may be used for loans as provided under this section and to pay 
the costs of administration of the fund. Annually, the Bank may deduct a service fee for 
administering the fund.
8. The fund must be audited in accordance with section 6 -09-29. The cost of the audit 
and any other actual costs incurred by the Bank on behalf of the fund must be paid 
from the fund.
9. The Bank shall deposit medical facility infrastructure loan repayments in the fund.

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