2022-10-28T09:01:19-05:00 2021-12-31 410746749 CLIFTONLARSONALLEN LLP 220 S 6TH STREET SUITE 300 MINNEAPOLIS MN 55402 990 2021-01-01 845163224 WELIA HEALTH WELI 3206791212 301 SOUTH HIGHWAY 65 MORA MN 55051 JOSHUA ASP CFO 3206791212 2022-10-27 1 JOSHUA ASP XXX-XX-XXXX KOREY BOELTER P00775161 6123764500 2022-10-27 0 AAL1 IAL1 2021 2022-09-23 18:48:47Z X RANDY ULSETH 301 SOUTH HIGHWAY 65 MORA MN 55051 291587288 0 X WWW.WELIAHEALTH.ORG X 2020 MN TO SUPPORT AND IMPROVE THE HEALTH OF THE COMMUNITIES WE SERVE. 8 6 625 55 23598 20036 188654870 58298687 1263271 997583 249214411 90339532 0 26656312 0 0 28148930 145144774 104069637 186758390 83130592 103627798 X TO SUPPORT AND IMPROVE THE HEALTH OF THE COMMUNITIES WE SERVE. 0 0 136392066 90339532 58582615 WELIA HEALTH PROUDLY SERVES ITS SURROUNDING COMMUNITIES WITH THE GOAL OF ENSURING PATIENTS' NEEDS AND HEALTH GOALS ARE ACHIEVED. DURING 2021, WELIA PROVIDED CARE FOR A TOTAL OF 3,862 INPATIENT DAYS. WELIA ENCOUNTERED 94,578 CLINIC VISITS, 9,511 EYE CLINIC VISITS, 7,664 URGENCY VISITS, 13,665 EMERGENCY VISITS, 3,047 SURGERIES, AND 220 NEWBORN DELIVERIES. WELIA HEALTH ALSO ENSURES HEATH CARE IS AFFORDED TO ALL PATIENTS REGARDLESS OF FINANCIAL SITUATION. STRONG EFFORTS ARE MADE TO ENSURE CHARITY CARE IS GRANTED FOR THOSE THAT QUALIFY. IN 2021, $798,280 IN SERVICES WERE PROVIDED TO CHARITY CARE PATIENTS. WELIA CONTINUES TO HAVE A VERY LARGE PRESENCE IN THE LOCAL COMMUNITIES BY PROMOTING HEALTH AND WELLNESS THROUGH VARIOUS PROGRAMS OFFERED TO THE PUBLIC, HIGHWAY CLEAN UP MISSIONS, SUPPORT GROUPS, SPORTS PHYSICALS FOR STUDENT ATHLETES, BLOOD DRIVES, EMS COVERAGE AT COMMUNITY EVENTS, 48-HOUR WELL-BABY CHECKS, TRANSPORTATION, ETC. 136392066 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 1 1 1 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 1 88 0 625 1 1 1 0 0 0 0 0 0 0 0 0 0 0 X 8 6 0 0 0 0 0 1 0 1 1 0 0 1 1 1 1 1 1 1 0 1 0 MN X JOSHUA ASP 3206791212 301 SOUTH HIGHWAY 65 MORA MN 55051 RANDY ULSETH CEO 40.00 X 393881 0 17244 BRADLEY QUALEY UROLOGIST 40.00 X 250881 0 17244 ROBERT WOODS ANESTHESIA DIRECTOR 40.00 X 165433 0 19811 THOMAS NELSON SURGEON 24.00 X 160260 0 17244 MATTHEW HAMIEL CRNA 40.00 X 143996 0 21387 BENJAMIN SICKLER CRNA 40.00 X 141889 0 19737 JOSHUA ASP CFO 40.00 X 129236 0 10953 DR PETER DONNER BOARD MEMBER & PHYSICIAN 40.00 X 63944 0 8912 DR JACK SCHWINGHAMER BOARD MEMBER & PHYSICIAN 40.00 X 51082 0 11406 KIM SMITH CHAIR 2.00 X X 2188 0 0 TERESA TERI HEGGERNES BOARD MEMBER 1.00 X 900 0 0 AMY ANDERSON VICE CHAIR 1.00 X X 700 0 0 DR KATHI ELLIS BOARD MEMBER (THROUGH DECEMBER 2021) 1.00 X 600 0 0 CARL PEDERSON SECRETARY/TREASURER 1.00 X X 300 0 0 LESLIE LES NIELSEN BOARD MEMBER 1.00 X 0 0 0 BECCI STEFFEN BOARD MEMBER 1.00 X 0 0 0 1505290 0 143938 12 0 1 0 CENTRAL MINN DIAGNOSTIC INC PO BOX 158 MILACA MN 56353 IMAGING 1179940 ST CLOUD ORTHOPEDICS 1901 CONNECTICUT AVE S SARTELL MN 56377 CONTRACTED PROVIDERS 243012 SISU MEDICAL SOLUTIONS LLC 4960 MILLER TRUNK HWY STE 500 HERMANTOWN MN 55811 IT 213413 MARS LLC 911 LUND BLVD STE 100 ANOKA MN 55303 COLLECTIONS 142200 CUYUNA REGIONAL MEDICAL CENTER 320 E MAIN ST CROSBY MN 56441 CONTRACTED PROVIDERS 139158 11 188381733 273137 103784944 188654870 PATIENT SERVICE REVENUE 621110 53615231 53615231 PHARMACY 621110 4483777 4483777 NUTRITIONAL SERVICES 621110 109044 109044 CONTRACT SERVICES 621110 90635 90635 58298687 1320986 1320986 124245 0 124245 124245 124245 42315162 42372877 -57715 -57715 -57715 JOINT VENTURE 900099 580154 23598 556556 INCENTIVES 900099 237133 237133 DISCOUNTS 900099 21960 21960 34091 24835 9256 873338 249214411 58582615 23598 1953328 89583675 89583675 755857 755857 691346 135345 556001 20012774 18811751 1201023 1004968 934077 70891 3590762 3297101 293661 1356462 1241750 114712 78863 78863 7797 7797 6562091 5538588 1023503 226725 226725 557901 195927 361974 133001 133001 1255509 901470 354039 22989 21311 1678 34031 31533 2498 886702 886702 3080528 984242 2096286 341544 341544 UBI TAXES 6270 6270 MEDICAL SUPPLIES 11252881 11252881 BAD DEBT 1965749 1965749 CARE TAXES 719283 719283 1017066 740809 276257 145144774 136392066 8752708 0 41852561 52617340 21068682 2986464 1619470 114781405 53691796 0 61089609 4649750 0 874514 0 186758390 9745818 8238718 59093233 0 6052823 0 83130592 X 0 103627798 0 103627798 0 186758390 104069637 -441839 0 X X 0 1 X 1 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 1996692 1996692 62654155 20148970 42505185 46846567 31777290 15069277 3283991 1765536 1518455 61089609 LEASE PAYABLE 1157904 THIRD PARTY SETTLEMENTS ESTIMATED 4894919 6052823 X 156467291 -441839 -441839 156909130 92305281 92305281 249214411 52839493 0 52839493 92305281 92305281 145144774 PART X, LINE 2: THE SYSTEM IS A NONPROFIT CORPORATION AS DESCRIBED IN SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE (THE CODE) AND IS EXEMPT FROM FEDERAL INCOME TAXES ON RELATED INCOME PURSUANT TO SECTION 501(A) OF THE CODE. THE SYSTEM IS ALSO EXEMPT FROM STATE INCOME TAXES ON RELATED INCOME. THE SYSTEM IS ALSO ENGAGED, TO A LIMITED EXTENT, IN CERTAIN ACTIVITIES SUBJECT TO TAXATION AS UNRELATED BUSINESS INCOME (UBI). UBI IS NOT SIGNIFICANT. IN ORDER TO ACCOUNT FOR ANY UNCERTAIN TAX POSITIONS, THE SYSTEM ASSESSES WHETHER IT IS MORE LIKELY THAN NOT THAT A TAX POSITION WILL BE SUSTAINED UPON EXAMINATION OF THE TECHNICAL MERITS OF THE POSITION, ASSUMING THE TAXING AUTHORITY HAS FULL KNOWLEDGE OF ALL INFORMATION. IF THE TAX POSITION DOES NOT MEET THE MORE LIKELY THAN NOT RECOGNITION THRESHOLD, THE BENEFIT OF THE TAX POSITION IS NOT RECOGNIZED IN THE ACCOMPANYING FINANCIAL STATEMENTS. THE SYSTEM HAS NOT RECORDED ANY ASSETS OR LIABILITIES RELATED TO UNCERTAIN TAX POSITIONS OR UNRECOGNIZED TAX BENEFITS AS OF DECEMBER 31, 2021. PART XI, LINE 4B - OTHER ADJUSTMENTS: BAD DEBT EXPENSE 1,965,749. CHARITY CARE 755,857. LIABILITIES TRANSFERRED FROM KANABEC COUNTY 89,583,675. PART XII, LINE 4B - OTHER ADJUSTMENTS: BAD DEBT EXPENSE INCLUDED IN EXPENSES 1,965,749. CHARITY CARE INCLUDED IN EXPENSES 755,857. LIABILITIES TRANSFERRED FROM KANABEC COUNTY 89,583,675. 1 1 X 1 X 275.000000000000 1 X 275.000000000000 1 0 1 1 939645 939645 0.00660 13678856 10849092 2829764 0.01980 14618501 10849092 3769409 0.02640 221262 41500 179762 0.00130 717814 717814 0.00500 939076 41500 897576 0.00630 15557577 10890592 4666985 0.03270 1 1965749 0 20597920 20391941 205979 X 1 0 1 1 WELIA HEALTH 301 HIGHWAY 65 S MORA MN 55008 WWW.WELIAHEALTH.ORG 405147 845163224 X X X X WELIA HEALTH 1 1 1 0 0 1 X 275.000000000000 275.000000000000 X X X X 1 1 X X 1 X SEE LINE 16J X SEE LINE 16J X SEE LINE 16J X X X 1 X 0 X X X X 1 0 0 WELIA HEALTH PART V, SECTION B, LINE 2: ON JULY 1, 2021, WELIA HEALTH CONVERTED FROM A COUNTY-OWNED GOVERNMENTAL ENTITY THAT WAS EXEMPT UNDER IRC SECTION 115 TO AN INDEPENDENT PUBLIC CHARITY UNDER IRC SECTION 501(C)(3). THE INITIAL COMMUNITY HEALTH NEEDS ASSESSMENT WILL BE COMPLETED BY THE YEAR ENDING DECEMBER 31, 2023. WELIA HEALTH PART V, SECTION B, LINE 16J: WELIA HEALTH'S FINANCIAL ASSISTANCE APPLICATION AND PLAIN LANGUAGE SUMMARY ARE AVAILABLE ONLINE AT WWW.WELIAHEALTH.ORG/PATIENT-RESOURCES/BILLING/. PART V, SECTION B, LINES 13-24: AS PART OF WELIA HEALTH'S CONVERSION FROM A GOVERNMENTAL ENTITY TO A 501(C)(3) ORGANIZATION, WE ARE IN THE PROCESS OF UPDATING ALL OF OUR POLICIES AND PROCEDURES TO BE 501(R)-COMPLIANT WITH THE GOAL OF ACHIEVING FULL COMPLIANCE BY DECEMBER 31, 2022. 2 1 - WELIA HEALTH PINE CITY CLINIC 1425 MAIN STREET N PINE CITY MN 55063 PROVIDER-BASED RURAL HEALTH CLINIC 2 - WELIA HEALTH HINCKLEY CLINIC 620 SANDY LANE HINCKLEY MN 55037 PROVIDER-BASED RURAL HEALTH CLINIC PART I, LINE 3C: TO QUALIFY FOR WELIA'S WELIACARE PROGRAM, (A) THE PATIENT MUST HAVE FAMILY INCOME AT OR BELOW 275% OF THE THEN-CURRENT FEDERAL POVERTY GUIDELINES OR QUALIFY TO FILE IRS FORM 4029, (B) HAVE FAMILY LIQUID ASSETS LESS THAN $20,000, (C) LIVE IN EITHER WISCONSIN OR MINNESOTA, AND (D) RECEIVE EMERGENCY OR MEDICALLY NECESSARY CARE FROM WELIA HEALTH. PART I, LINE 7: THE AMOUNTS REPORTED IN PART I, LINE 7 WERE CALCULATED USING THE WORKSHEETS IN THE 2021 SCHEDULE H INSTRUCTIONS, INCLUDING USE OF A COST-TO-CHARGE RATIO. PART I, LINE 7, COLUMN (F): THE BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 25, COLUMN (A), BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE IN THIS COLUMN IS $ 1,965,749. PART III, LINE 2: IN EVALUATING THE COLLECTABILITY OF PATIENT ACCOUNTS RECEIVABLE, THE SYSTEM ANALYZES PAST RESULTS AND IDENTIFIES TRENDS FOR EACH OF ITS MAJOR PAYOR SOURCES OF REVENUE TO ESTIMATE THE APPROPRIATE NET REALIZABLE VALUE. MANAGEMENT REGULARLY REVIEWS DATA ABOUT THESE MAJOR PAYOR SOURCES OF REVENUE IN EVALUATING THE SUFFICIENCY OF THE ALLOWANCE FOR DOUBTFUL ACCOUNTS.FOR RECEIVABLES ASSOCIATED WITH SERVICES PROVIDED TO PATIENTS WHO HAVE THIRD PARTY COVERAGE, THE NET REALIZABLE VALUE IS BASED ON THE ESTIMATED CONTRACTUAL REIMBURSEMENT PERCENTAGES, WHICH IS BASED ON CURRENT CONTRACT PRICES OR HISTORICAL CLAIMS PAID DATA BY PAYOR. FOR UNINSURED PATIENTS (WHICH INCLUDES BOTH PATIENTS WITHOUT INSURANCE AND PATIENTS WITH DEDUCTIBLE AND COPAYMENT BALANCES DUE WHICH THIRD PARTY COVERAGE EXISTS FOR A PORTION OF THE BILL), THE NET REALIZABLE VALUE IS DETERMINED USING ESTIMATES OF HISTORICAL COLLECTION EXPERIENCE. THESE ESTIMATES ARE ADJUSTED FOR RECOVERIES AND ANY ANTICIPATED CHANGES IN TRENDS, INCLUDING SIGNIFICANT CHANGES IN PAYOR MIX, ECONOMIC CONDITIONS OR TRENDS IN FEDERAL AND STATE GOVERNMENTAL HEALTH CARE COVERAGE. PART III, LINE 3: THE ORGANIZATION DOES NOT HAVE A METHOD OF REASONABLY ESTIMATING THE PORTION OF ITS BAD DEBT EXPENSE ATTRIBUTABLE TO PATIENTS WHO WOULD QUALIFY FOR CHARITY CARE BUT FAILED TO COMPLETE A CHARITY CARE APPLICATION. PART III, LINE 4: SEE THE "PATIENT ACCOUNTS RECEIVABLES AND CREDIT POLICY" SECTION OF NOTE 1 ON PAGES 8-9 OF THE ATTACHED AUDITED FINANCIAL STATEMENTS FOR A DESCRIPTION OF HOW WELIA HEALTH CALCULATES BAD DEBT EXPENSE. PART III, LINE 8: THE MEDICARE REVENUES AND ALLOWABLE COSTS WERE CALCULATED USING THE 2021 MEDICARE COST REPORT. PART VI, LINE 2: WELIA HEALTH IS CONSTANTLY ASSESSING THE HEALTH NEEDS OF THE COMMUNITY. ONE WAY WELIA HEALTH ASSESSES COMMUNITY NEEDS IS BY HOSTING A PATIENT FAMILY ADVISORY COMMITTEE THROUGH WHICH INPUT IS SOLICITED FROM THE PATIENT COMMUNITY. WELIA HEALTH ALSO CONDUCTS PATIENT SURVEYS TO GATHER INPUT ON THE NEEDS OF THE COMMUNITY. FINALLY, WELIA HEALTH REGULARLY CONDUCTS STRATEGIC PLANNING INVOLVING COMMUNITY MEMBERS, WELIA HEALTH LEADERSHIP AND THE WELIA HEALTH BOARD OF DIRECTORS. THESE STRATEGIC PLANNING SESSIONS INCLUDE AN IN-DEPTH ASSESSMENT OF COMMUNITY HEALTH NEEDS. PART VI, LINE 3: WELIA HEALTH OFFERS WELIACARE TO ALL PATIENTS WHO ARE UNABLE TO FINANCIALLY PAY THEIR MEDICAL DEBT DUE TO INCOME RESTRAINTS. WE EMPLOY TWO PATIENT FINANCIAL REPRESENTATIVES WHO ASSIST THE PUBLIC IN FILLING OUT WELIACARE APPLICATIONS OR REFERRING THEM TO OTHER AGENCIES WITHIN OUR CARE AREA FOR GOVERNMENT ASSISTANCE PROGRAMS. WELIA HEALTH EDUCATES INTERNAL STAFF AND OUR OUTSOURCED BILLING AGENCY ON THE WELIACARE PROGRAM AND WILL OFFER PATIENTS THE APPLICATION OR REFER TO OUR PATIENT FINANCIAL REPRESENTATIVES IF THEY EXPRESS INTEREST. PART VI, LINE 4: WELIA HEALTH SERVES APPROXIMATELY 45,000 RESIDENTS IN KANABEC AND PINE COUNTIES IN MINNESOTA. PINE AND KANABEC COUNTIES ARE THE 80TH AND 81ST, RESPECTIVELY, POOREST COUNTIES OUT OF 87 IN MINNESOTA. KANABEC COUNTY IS DESIGNATED AS A LOW-INCOME HEALTH PROFESSIONAL SHORTAGE AREA (HPSA). PINE COUNTY IS DESIGNATED AS A GEOGRAPHIC HPSA. PART VI, LINE 5: WELIA HEALTH HAS A ROBUST COMMUNITY BENEFIT PROGRAM, SUPPORTING ITS MISSION OF IMPROVING THE HEALTH OF THE COMMUNITIES. WE HAVE A LONGSTANDING COMMITMENT TO THE MEDICALLY UNDERSERVED POPULATION AND CONTINUE TO SHOW THIS COMMITMENT THROUGH OUR GENEROUS CHARITY CARE POLICY, PROVIDING FREE AND DISCOUNTED SERVICES FOR THE UNINSURED AND UNDERINSURED. WELIA HEALTH CONTINUES TO DEVELOP, PROVIDE AND PARTICIPATE IN PROGRAMS AND ACTIVITIES ON VARIOUS HEALTH AND WELLNESS TOPICS, OFTEN FOR LITTLE OR NO FINANCIAL GAIN. OUR WORK ALSO SUPPORTS A COLLABORATIVE FRAMEWORK MODEL WITH OUR COMMUNITY PARTNERS FOR IMPROVING COMMUNITY HEALTH. IN ADDITION, WE PARTICIPATE IN MANY HEALTH PROFESSIONAL EDUCATION AND TRAINING OPPORTUNITIES ACROSS MULTIPLE DISCIPLINES TO FULFILL THE NEEDS OF THE HEALTH CARE INDUSTRY. PART VI, LINE 7, REPORTS FILED WITH STATES MN 1 KANABEC COUNTY 301 S HIGHWAY 65 MORA MN 55051 416005815 KANABEC COUNTY 89583675 0 TRANSFER OF LIABILITIES UPON CONVERSATION 1 0 CHARITY CARE 426 755857 PART I, LINE 2: ASSISTANCE TO INDIVIDUALS IS LIMITED TO DISCOUNTS ON SERVICES PROVIDED BY WELIA HEALTH, SO INDIVIDUALS ARE NEVER GIVEN CASH OR OTHER ASSETS. X X X X 0 0 0 0 0 0 0 0 0 RANDY ULSETH CEO 235229 0 158652 0 0 0 8700 0 8544 0 411125 0 0 0 BRADLEY QUALEY UROLOGIST 249440 0 1441 0 0 0 8700 0 8544 0 268125 0 0 0 ROBERT WOODS ANESTHESIA DIRECTOR 124139 0 41294 0 0 0 8700 0 11111 0 185244 0 0 0 THOMAS NELSON SURGEON 158798 0 1462 0 0 0 8700 0 8544 0 177504 0 0 0 MATTHEW HAMIEL CRNA 93814 0 50182 0 0 0 8482 0 12905 0 165383 0 0 0 BENJAMIN SICKLER CRNA 95146 0 46743 0 0 0 8626 0 11111 0 161626 0 0 0 X 1 20248946 NET BOOK VALUE X 1 1621273 NET BOOK VALUE X 1 63620318 NET BOOK VALUE X 1 2403573 NET BOOK VALUE X ACCOUNTS RECEIVABLE 1 13969774 NET BOOK VALUE X PREPAID EXPENSES 1 1921060 NET BOOK VALUE 0 0 0 0 FORM 990, PART VI, SECTION A, LINE 1A THE BOARD OF DIRECTORS MAY ESTABLISH COMMITTEES HAVING THE AUTHORITY OF THE BOARD IN THE MANAGEMENT OF THE BUSINESS OF THE CORPORATION. COMMITTEES WILL BE ESTABLISHED BY RESOLUTION AND WILL HAVE AUTHORITY ONLY TO THE EXTENT PROVIDED IN THE RESOLUTION. EXCEPT AS MAY BE PROVIDED BY LAW IN THE CASE OF A SPECIAL LITIGATION COMMITTEE, COMMITTEES WILL AT ALL TIMES BE SUBJECT TO THE DIRECTION AND CONTROL OF THE BOARD. FORM 990, PART VI, SECTION A, LINE 7A THE KANABEC COUNTY BOARD OF COMMISSIONERS APPOINTS ONE OF ITS MEMBERS TO THE BOARD OF DIRECTORS. THE COUNTY BOARD OF COMMISSIONERS MAY ALSO REMOVE THE COUNTY-APPOINTED BOARD MEMBER AT ANY TIME. FORM 990, PART VI, SECTION B, LINE 11B THE FORM 990 WAS PREPARED BY THE ORGANIZATION'S INDEPENDENT CPA WITH INFORMATION PROVIDED BY MANAGEMENT. THE CFO AND CEO WILL REVIEW THE FINAL 990. A COPY OF THE 990 WILL BE PRESENTED TO THE BOARD PRIOR TO ITS FILING. FORM 990, PART VI, SECTION B, LINE 12C WELIA HEALTH'S CONFLICT OF INTEREST POLICY REQUIRES ALL BOARD MEMBERS AND KEY SALARIED OFFICERS TO FULLY DISCLOSE ANY INTEREST THAT MIGHT RESULT IN A CONFLICT OF INTERESTS. ONCE A POTENTIAL CONFLICT IS DISCLOSED, THEINDIVIDUAL MAY NOT PARTICIPATE IN DISCUSSIONS OR IN THE ORGANIZATION'S ACTIOSN REALTED TO THE TRANSACTION. FORM 990, PART VI, SECTION B, LINE 15A THE EXECUTIVE COMMITTEE OF THE BOARD USES AN INDEPENDENT CONSULTING FIRM TO DETERMINE AND EVALUATE THE CEO'S COMPENSATION. THE CEO USES AN INDEPENDENT CONSULTING FIRM TO DETERMINE THE COMPENSATION OF OTHER EXECUTIVES. THE MOST RECENT COMPENSATION REVIEW WAS CONDUCTED IN 2021. FORM 990, PART VI, SECTION C, LINE 19 WELIA HEALTH DOES NOT MAKE ITS GOVERNING DOCUMENTS OR CONFLICT OF INTEREST POLICY AVAILABLE TO THE PUBLIC. THE FINANCIAL STATEMENTS ARE ATTACHED TO THE PUBLIC DISCLOSURE COPY OF THE FORM 990. FORM 990, PART XII, LINE 2C THE PROCESS FOR OVERSIGHT AND SELECTION OF AN INDEPENDENT ACCOUNTANT HAS NOT CHANGED FROM THE PRIOR YEAR.