2018-11-06T08:01:51-06:00 2017-12-31 450250958 Eide Bailly LLP 800 Nicollet Mall Ste 1300 Minneapolis MN 554027033 990 2017-01-01 454165628 United Hospital District Inc UNIT 5075263273 515 S Moore Street Blue Earth MN 56013 Patrick Justin CFO 5075263273 2018-10-31 1 Kim Hunwardsen CPA P00484560 6122536500 2018-10-31 8.39.233.43 2018-10-31 11:57:48 CD P D8A1E5117AA53286D53F57459EBB2DE5C7CA50FC F9BEE9501A3B4F00F190E63700B8BF2BC70C7B96 2017 2018-06-14 16:35:46Z Richard Ash 515 S Moore Street Blue Earth MN 56013 33457143 0 X www.uhd.org X 2011 MN Provision of health care services 10 8 282 48 0 0 110490 94732 31693147 33242394 57410 116982 2350 2350 31863397 33456458 4701 6070 0 0 15434067 16947059 0 0 0 16223349 15252793 31662117 32205922 201280 1250536 39731237 41330603 12124213 12473043 27607024 28857560 X At United Hospital District, we exist to provide and promote appropriate health care services to the communities we serve, doing so in a safe and healing environment which supports our patient-centered care philosophy. 1 0 28579503 6070 33242394 United Hospital District, Inc. operates a 25-bed critical access hospital in Blue Earth, Minnesota. The Hospital also operates medical clinics in Blue Earth, Wells, Winnebago and Fairmont, Minnesota as well as a 24-bed adolescent treatment center in Winnebago, Minnesota. In 2017, United Hospital District, Inc. provided $335,000 worth of financial assistance based on established rates of charges foregone. The estimated costs of the charges forgone was $169,000 based upon an overall cost-to-charge ratio calculation. 28579503 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 0 0 1 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 70 0 1 282 1 0 0 0 0 0 0 0 0 0 0 X 10 8 0 0 0 0 0 1 0 1 1 0 0 1 1 1 1 1 1 1 0 0 MN X Patrick Justin 5075267907 515 S Moore Street Blue Earth MN 56013 Melanie Humburg Chairman 1.00 X X 700 0 0 Larry Anderson Vice President 1.00 X X 750 0 0 Barbara Hanson Secretary 1.00 X X 525 0 0 Jeanette Eichorn Treasurer 1.00 X X 750 0 0 Roger Hanson Board Member 1.00 X 700 0 0 Douglas Johanson Board Member 1.00 X 550 0 0 Aaron Johnson MD Board Member/Physician 40.00 X 273254 0 21684 Bobby Karp MD Board Member/Physician 40.00 X 404663 0 34572 Cheryl Keithahn Board Member 1.00 X 550 0 0 Wyatt Rollenhagen Board Member 1.00 X 350 0 0 Richard Ash CEO 40.00 X 201698 0 32936 Patrick Justin CFO 40.00 X 134303 0 14874 Alex Wong Surgeon 40.00 X 458092 0 38460 Mary Trites Physician 40.00 X 226016 0 16045 Carmelle McHarg CRNA 40.00 X 220905 0 18047 Joseph Montanaro Physician 40.00 X 356935 0 32460 Mark Gundersen Physician 40.00 X 240299 0 30938 2521040 0 240016 19 0 1 0 Acute Care Inc 1609 N Ankeny Blvd Ankeny IA 50023 ED MD Coverage 1278387 Orthopaedic & Fracture Clinic 1431 Premier Drive Mankato MN 56001 Ortho MD's 400124 Cloudwave 100 Crowley Dr Marlborough MA 01752 Computer host 316224 CMDI 150 10th St NW Milaca MN 56353 CT & MRI Services 256941 Meditech Meditech Circle Westwood MA 02090 Computer Software provider 146966 9 94732 25000 94732 Patient Service Revenue 621110 31822069 31822069 340B Program Revenue 621110 1172414 1172414 Other Supporting Revenue 900099 175755 175755 Equity earnings in CDMI 900099 67060 67060 Electronic Health Records 900099 5096 5096 33242394 117667 117667 2350 0 2350 2350 2350 685 -685 -685 -685 33456458 33242394 0 119332 X 6070 6070 1128658 719865 408793 12236422 11149891 1086531 549342 503449 45893 2138290 1921153 217137 894347 796416 97931 17838 17838 62493 62493 4184612 3514454 670158 3688 2326 1362 857219 543868 313351 563030 25694 537336 709110 703876 5234 172079 156902 15177 117017 98690 18327 361773 361773 2045470 2045470 150397 142144 8253 Medical Supplies 3291132 3291132 Bad Debt 1454713 1454713 MN Care Tax 273483 273483 Equipment Rental/Repair 220746 214177 6569 767993 653957 114036 32205922 28579503 3626419 0 10570138 10990346 4515086 5434827 71429 164286 172250 194788 861631 923685 91128 116122 45719138 26101652 20643596 19617486 2402900 3564114 403079 324949 39731237 41330603 2434456 2608745 9468757 8715335 221000 1148963 12124213 12473043 X 27607024 28857560 27607024 28857560 39731237 41330603 1250536 0 X 0 1 X 1 0 X 632000 632000 29918882 14774962 15143920 920458 457671 462787 14136283 10869019 3267264 111515 111515 19617486 Estimated 3rd Party Payor Settlements 1148963 1148963 X 32001745 -1454713 -1454713 33456458 0 33456458 30751209 0 30751209 1454713 1454713 32205922 Part X, Line 2: The Hospital is organized as a Minnesota nonprofit corporation and has been recognized by the Internal Revenue Service (IRS) as exempt from federal income taxes under Internal Revenue Code Section 501(c)(3). The Hospital is annually required to file a Return of Organization Exempt from Income Tax (Form 990) with the IRS. In addition, the Hospital is subject to income tax on net income that is derived from business activities that are unrelated to its exempt purpose. The Hospital believes that they have appropriate support for any tax positions taken affecting its annual filing requirements, and as such, does not have any uncertain tax positions that are material to the financial statements. The Hospital would recognize future accrued interest and penalties related to unrecognized tax benefits and liabilities in income tax expense if such interest and penalties are incurred. Part XI, Line 2d - Other Adjustments: Bad debt expense included in revenue for financial statements -1,454,713. Part XII, Line 4b - Other Adjustments: Bad debt expense included in revenue for financial statements 1,454,713. 1 1 X 1 X 1 X 275.000000000000 0 1 1 0 0 169000 169000 0.00550 6241858 4068827 2173031 0.07070 6410858 4068827 2342031 0.07620 4046851 1223621 2823230 0.09180 4046851 1223621 2823230 0.09180 10457709 5292448 5165261 0.16800 0 1454713 363678 7727831 7768099 -40268 X 1 1 1 1 United Hospital District 515 S Moore Street Blue Earth MN 56013 www.uhd.org 375736 X X X X 3 Provider based clinics, 1 Fee for service clinic United Hospital District 1 0 0 1 X X X X X X X X X 17 1 0 0 1 X See Schedule H, Part V, Line 10a X 1 17 1 https://www.uhd.org/community-needs-assessment.php 0 1 X 200.000000000000 275.000000000000 X 1 1 X X X X X 1 X www.uhd.org/billing.php X www.uhd.org/billing.php X www.uhd.org/billing.php X X X X X 1 X 0 X X X X 1 X 0 0 United Hospital District Part V, Section B, Line 5: An external consulting firm was subcontracted to perform the assessment, data collection and analysis. Two focus groups were held. The first was on 3-23-17 in Wells, Minnesota and the second group on 3-31-17 in Blue Earth, Minnesota. The 68 group members were recruited by phone to invite their participation with an email follow-up reminder. Due to weather constraints, the final sessions had 12 participants in the 2 groups. The stakeholders consisted of representation from area school districts, city government and numerous businesses. United Hospital District Part V, Section B, Line 11: The CHNA conducted in 2017 was our first one after becoming a tax exempt 501(c)(3) organization as of January 1, 2015. The CHNA was completed in September 2017 and approved by the Hospital Board on October 3rd, 2017. The needs identified in the report of findings, while partly highlighting specific service gaps, largely centered on issues related to healthy living and lifestyles. As a result, three key goals were identified as well as action items to address those goals. The goals identified in our action plan are as follows:**Goal 1: Raise awareness of healthcare and healthcare-related services currently provided by UHD*Action Item A: Review and update existing print and online materials, both available to the public and distributed internally to UHD staff and partners*Action Item B: Assess and expand public education and public information activities specifically related to:a) smoking cessation, specifically including smoking cessation options for pregnant womenb) weight loss/weight controlc) healthy dietsd) exercise/activitye) moderation in alcohol consumption*Action Item C: Build a system for regular periodic review and assessment of the activities executed under this goal to determine success and make changes as necessary. This activity should begin with determining both outcome/impact and process indicators of success.**Goal 2: Service collaboration and coordination with external community partners*Action Item A: Develop outreach activities based on the CHNA report of findings and other available resources to solicit interest in, and partners for, a more formalized system of multiorganizational community support for community residents. As the hospital's identified single point of contact for community relations and collaborations, the CEO should lead this effort.*Action Item B: Based on (A) above, UHD should actively participate in the implementation of a coordinated community support information and referral service. This includes participation in service coordination activities led by other agencies serving UHD's service area.**Goal 3: Operational feasibility planning to address potential service additions*Action Item A: Based on the information contained in the CHNA report of findings and other available information, develop an inventory of service gaps and personnel needs.*Action Item B: Develop potential financial and operational plans to address the identified service gaps and personnel needs. Due to time constraints for the rest of that year, no further action was taken in 2017 to implement the three goals as set forth in the Plan. United Hospital District Part V, Section B, Line 13h: Documents that may be reviewed include completed application, recent tax statements, bank denial and MA denial. The Organization also follows the state agreement. United Hospital District Part V, Section B, Line 15e: We have certified staff who assist with the MN State Exchange and MA. They also provide guidance with every patient's insurance carrier where needed. 2 1 - UHD Home Health and Hospice 125 South Main Street Blue Earth MN 56013 Comprehensive home care Hospice Program 2 - Adolescent Treatment Center 620 1st Avenue SW Winnebago MN 56098 Children's residential, Supervised living, Chemical dependency treatment Part I, Line 7: Charity care expense was converted to cost on line 7a based on an overall cost-to-charge ratio addressing all patient segments. Unreimbursed Medicaid on line 7b and subsidized health services on line 7g were determined using the costing methods to prepare the cost reports. Part I, Ln 7 Col(f): The amount of bad debt expense removed from the denominator is $1,454,713. Part III, Line 2: Bad debt expense is reported as charges as recorded by the organization. All discounts and payments on a patient's account are accounted for prior to determining bad debt expense. Part III, Line 3: The Organization estimates that 25% of bad debt expense is attributable to patients eligible for financial assistance under the financial assistance policy. We estimate that 25% of those who should have completed financial assistance forms and applications could have qualified for financial assistance had they applied. Part III, Line 4: The footnote to the Organization's financial statements can be found on page 8 of the attached audited financial statements. Part III, Line 8: United Hospital District is a critical access hospital. There was a shortfall for 2017 due to sequestration. Even though Medicare was at a loss, the Hospital provides services to these patients because access to healthcare and individual's health is important to the Hospital. Therefore, the Medicare shortfall is considered a community benefit.Medicare allowable costs were obtained from the 2017 Medicare cost report.The Medicare Cost Report is completed based on the rules and regulationsset forth by the Centers for Medicare and Medicaid Services. Part III, Line 9b: Within 7 days after an insurance payment, the patient will start receiving monthly billings. Statements are sent on a monthly cycle basis. If no payment is received 30 days after the statement went out, the patient is contacted by phone. If no payment is received for 90 days, the patient is contacted by letter to advise him or her of further collection actions to be taken. When agreed upon amounts are not paid off, arrangements can be made for a series of payments to fulfill a patient's obligation. Each account is reviewed by a business office staff member before placing with a collection agency. A financial assistance application submitted by a patient will be processed for at least 240 days following their first dayof care. If an individual submits a financial assistance application after collection actions have started, collection actions will be suspended until financial assistance eligibility is determined. If an individual is determined to be eligible for financial assistance, no further collection actions will be taken. If an individual is determined to be eligible for financial assistance after collection actions have started, the collection actions will be reversed. Part VI, Line 2: UHD has standing advisory committees with representation from our communities for Home Health/Hospice and ATCW. Input from the members helps set the strategies and initiatives for improvement. We've also had Focus Groups to address Obstetrical services and another for Orthopedic services. Our patient satisfaction survey incorporates a comments section which gives our patients a voice to make suggestions. Part VI, Line 3: Whether in person or on our web-site, UHD provides the following information for financial assistance: (1) posts its charity care policy, or a summary thereof, and financial assistance contact information in admissions areas, emergency rooms, and other areas of the organization's facilities in which eligible patients are likely to be present; (2) provides a copy of the policy, or a summary thereof, and financial assistance contact information to patients as part of the intake process; (3) provides a copy of the policy, or a summary thereof, and financial assistance contact information to patients with discharge materials; (4) includes the policy, or a summary thereof, along with financial assistance contact information, in patient bills; and/or (5) discusses with the patient the availability of various government benefits, such as Medicaid or state programs, and assists the patient with qualification for such programs, where applicable. In addition, the Business Office has several certified individuals to assist with applications for both State and Federal insurance plans. Part VI, Line 4: UHD is located in Blue Earth, Minnesota, a community of approximately 3,400 situated in the west central end of Faribault County. The county borders Martin County to the west, Freeborn County to the east, Blue Earth County to the north, and two Iowa counties, Kossuth and Winnebago, to the south.UHD is the only hospital serving Faribault County and the northern Iowa adjacent counties. Faribault County comprises 82% of UHD outpatient admissions while the remaining adjacent counties comprises 95% of all outpatient encounters. The population within a 10-mile radius of Blue Earth is about 9,000 and within a 20-mile radius is about 30,000.The closet full-service hospitals are in:Fairmont, MN - Mayo Clinic Health Systems - 22 miles westAlbert Lea, MN - Mayo Clinic Health Systems - 52 miles east (This hospital is shutting down in-patient services over the next 2 years.)Mankato, MN - Mayo Clinic Health Systems - 45 miles northEmmetsburg, IA - Palo Alto County Hospital - 66 miles southwest Part VI, Line 5: United Hospital District's current board members reside in the service area. Medical staff privileges for physicians are provided to all qualified care providers who also primarily reside in the service area. The Hospital also has relationships for certain specialists who provide their medical care in our clinics and hospital. All surplus funds are reinvested in the program areas for the hospital and clinics. X X 0 0 0 0 0 0 0 0 0 Aaron Johnson MD Board Member/Physician 222560 0 50694 0 0 0 0 0 23370 0 296624 0 0 0 Bobby Karp MD Board Member/Physician 308594 0 68944 0 27125 0 13012 0 23630 0 441305 0 0 0 Richard Ash CEO 201597 0 101 0 0 0 10447 0 23448 0 235593 0 0 0 Alex Wong Surgeon 424936 0 25102 0 8054 0 13500 0 26832 0 498424 0 0 0 Mary Trites Physician 200914 0 25102 0 0 0 8461 0 8602 0 243079 0 0 0 Carmelle McHarg CRNA 220803 0 102 0 0 0 10040 0 9496 0 240441 0 0 0 Joseph Montanaro Physician 326583 0 102 0 30250 0 13500 0 20873 0 391308 0 0 0 Mark Gundersen Physician 225613 0 14686 0 0 0 11978 0 20792 0 273069 0 0 0 Bobby Karp Medical Provider Signing Incentive X 125000 25000 0 1 1 Alex Wong Medical Provider Signing Incentive X 50000 14286 0 1 1 Joseph Montanaro Medical Provider Signing Incentive X 150000 125000 0 1 1 164286 Form 990, Part III, line 2 On 9/29/17 a Urologist began seeing patients. Form 990, Part VI, Section A, line 1 The Organization has an Executive Committee consisting of the Chair, Vice Chair, Secretary and Treasurer. In addition, the CEO is an ex-officio, non-voting member of the Executive Committee. The Chair of the Board of Directors is the Chair of the Executive Committee. The Executive Committee has the authority of the Board of Directors in the management of the business of the Organization in intervals between meetings of the Board of Directors. Form 990, Part VI, Section A, line 7a The Board of Directors consists of no fewer than seven and no more than fifteen members. Three "District Directors" are appointed by the United Hospital District Board of Directors. There can be up to two "At-Large Directors" who are elected by the Board of Directors but need not be residents of the Geographic Service Area. There is one Ex Officio director, who is the physician serving as the Chief of Medical Staff of the hospital. The remaining members of the Board of Directors are "Area Directors" who are elected by the Board of Directors of this corporation and must be residents of the Geographic Service Area. The Geographic Service Area means all of the cities and townships comprising the District, plus any additional area contained within the lowest number of contiguous zip codes from which the hospital drew at least 75 percent of its inpatients during the previous fiscal year. Form 990, Part VI, Section B, line 11b The CFO reviews the Form 990 and a copy is provided to the board members prior to filing with the IRS. Form 990, Part VI, Section B, line 12c The organization has a conflict of interest policy in place which covers the officers and board members of the organization. Potential conflicts are reviewed and determined by the CEO and board chair. If an individual has a conflict of interest, they are asked to abstain from voting on the conflicting issue. Form 990, Part VI, Section B, line 15a CEO: The Executive Committee of the Board reviews salary surveys from the Minnesota Hospital Association in determining the salary for the CEO. Other officers: Similarly to the CEO, the results of the salary survey from the Minnesota Hospital Association is used in determining the salary for the remaining officers. The CEO approves these increases in compensation. The Senior Executive Suite, including the CEO, CFO, CNO and CMO approve the salaries for all other key employees and managers on a yearly basis. Form 990, Part VI, Section C, line 19 The governing documents, conflict of interest policy and financial statements are not made available to the public Form 990, Part IX, line 11g Outside Consultants/Purchased Services: Program service expenses 3,299,721. Management and general expenses 399,433. Fundraising expenses 0. Total expenses 3,699,154. Other Fees: Program service expenses 214,733. Management and general expenses 270,725. Fundraising expenses 0. Total expenses 485,458.