CHRISTIAN UNITY HOSPITAL CORPORATION: Form 990, tax year 2015
View the entire original 990 at ProPublica ↗
- Organization
- CHRISTIAN UNITY HOSPITAL CORPORATION (EIN 45-0310159)
- Tax period
- 2015-07-01 to 2016-06-30
- Filed
- 2017-05-15
- IRS object ID
- 201711359349304776
- Schema version
- 2015v3.0
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
- Return header
- Form 990
- Schedule A
- Schedule B
- Schedule C
- Schedule D
- Schedule H
- Schedule J
- Schedule K
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2017-05-15T11:27:32-05:00 | ReturnTs |
| Tax Period End | 2016-06-30 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 390758449 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | WIPFLI LLP | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 7601 FRANCE AVENUE SOUTH SUITE 400 | AddressLine1Txt |
| City | MINNEAPOLIS | CityNm |
| State Abbreviation | MN | StateAbbreviationCd |
| ZIP | 55435 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2015-07-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 450310159 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CHRISTIAN UNITY HOSPITAL CORPORATION | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | CHRI | BusinessNameControlTxt |
| Phone | 7013529365 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 164 WEST 13TH STREET | AddressLine1Txt |
| City | GRAFTON | CityNm |
| State Abbreviation | ND | StateAbbreviationCd |
| ZIP | 58257 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | ALAN O'NEIL | PersonNm |
| Person Title | CHIEF EXECUTIVE OFFICER | PersonTitleTxt |
| Phone | 7013529365 | PhoneNum |
| Signature | 2017-05-10 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | TIM A RITTER CPA | PreparerPersonNm |
| PTIN | P00732856 | PTIN |
| Phone | 9525483400 | PhoneNum |
| Preparation | 2017-05-10 | PreparationDt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2015 | TaxYr |
| Build TS | 2021-01-29 14:40:06Z | BuildTS |
Form 990 IRS990
Doing Business As Name DoingBusinessAsName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | UNITY MEDICAL CENTER | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | ALAN O'NEIL | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 164 WEST 13TH STREET | AddressLine1Txt |
| City | GRAFTON | CityNm |
| State Abbreviation | ND | StateAbbreviationCd |
| ZIP | 58257 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $11,112,881 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | WWW.UNITYMEDCENTER.COM | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1970 | FormationYr |
| Legal Domicile State | ND | LegalDomicileStateCd |
| Activity Or Mission | PROVIDE ACCESS TO QUALITY HEALTH CARE FOR THE REGION. | ActivityOrMissionDesc |
| Voting Members Governing Body | 9 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 8 | VotingMembersIndependentCnt |
| Total Employee | 137 | TotalEmployeeCnt |
| Total Volunteers | 30 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $561,684 | PYContributionsGrantsAmt |
| CY Contributions Grants | $504,334 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $9,340,742 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $10,494,096 | CYProgramServiceRevenueAmt |
| PY Investment Income | $0 | PYInvestmentIncomeAmt |
| CY Investment Income | $276 | CYInvestmentIncomeAmt |
| PY Other Revenue | $40,548 | PYOtherRevenueAmt |
| CY Other Revenue | $114,175 | CYOtherRevenueAmt |
| PY Total Revenue | $9,942,974 | PYTotalRevenueAmt |
| CY Total Revenue | $11,112,881 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $0 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $0 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $5,422,362 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $6,106,998 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $4,188,390 | PYOtherExpensesAmt |
| CY Other Expenses | $4,351,146 | CYOtherExpensesAmt |
| PY Total Expenses | $9,610,752 | PYTotalExpensesAmt |
| CY Total Expenses | $10,458,144 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $332,222 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $654,737 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $5,266,243 | TotalAssetsBOYAmt |
| Total Assets EOY | $5,516,233 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $3,000,458 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $2,595,711 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $2,265,785 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $2,920,522 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | UNITY MEDICAL CENTER PROVIDES ACCESS TO QUALITY HEALTH CARE FOR THE REGION. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $8,691,226 | ExpenseAmt |
| Grant | $0 | GrantAmt |
| Revenue | $10,552,598 | RevenueAmt |
| Desc | UNITY MEDICAL CENTER IS A 14 BED HEALTHCARE FACILITY, WHICH PROVIDES EMERGENCY CARE, ACUTE CARE SERVICES, OUTPATIENT SERVICES AND CLINICAL MEDICAL SERVICES TO THE RESIDENTS OF GRAFTON, NORTH DAKOTA AND SURROUNDING COMMUNITIES. THE FACILITY PROVIDES OUTREACH SERVICES SUCH AS PHYSICAL THERAPY, RESPIRATORY THERAPY, AND FLU VACCINATION CLINICS TO OTHER EMPLOYERS IN THE AREA AS WELL. FOR THE FISCAL YEAR ENDED JUNE 30, 2016 THE MEDICAL CENTER PROVIDED AS PART OF ITS MISSION 613 ACUTE DAYS, 961 SWING BED DAYS, 56 RESPITE DAYS AND 11,253 CLINIC VISITS. THE AMOUNT OF CHARGES FOREGONE FOR SERVICES PROVIDED UNDER THE ORGANIZATION'S CHARITY CARE POLICY WAS APPROXIMATELY $40,100 FOR THE FISCAL YEAR. TOTAL DIRECT AND INDIRECT COSTS RELATED TO THESE FOREGONE CHARGES WAS $29,700, BASED ON AN AVERAGE RATIO OF COSTS TO GROSS CHARGES. | Desc |
| Total Program Service Expenses | $8,691,226 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (1) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (1) | ScheduleBRequiredInd |
| Political Campaign Acty | 0 | PoliticalCampaignActyInd |
| Lobbying Activities | Yes (1) | LobbyingActivitiesInd |
| Subject To Proxy Tax | 0 | SubjectToProxyTaxInd |
| Donor Advised Fund | 0 | DonorAdvisedFundInd |
| Conservation Easements | 0 | ConservationEasementsInd |
| Collections Of Art | 0 | CollectionsOfArtInd |
| Credit Counseling | 0 | CreditCounselingInd |
| Temp Or Permanent Endowments | 0 | TempOrPermanentEndowmentsInd |
| Report Land Building Equipment | Yes (1) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | 0 | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | 0 | ReportProgramRelatedInvstInd |
| Report Other Assets | 0 | ReportOtherAssetsInd |
| Report Other Liabilities | 0 | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | 0 | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | 0 | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | Yes (1) | ConsolidatedAuditFinclStmtInd |
| School Operating | 0 | SchoolOperatingInd |
| Foreign Office | 0 | ForeignOfficeInd |
| Foreign Activities | 0 | ForeignActivitiesInd |
| More Than5000 K To Org | 0 | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividualsInd |
| Professional Fundraising | 0 | ProfessionalFundraisingInd |
| Fundraising Activities | 0 | FundraisingActivitiesInd |
| Gaming Activities | 0 | GamingActivitiesInd |
| Operate Hospital | Yes (1) | OperateHospitalInd |
| Audited Financial Stmt Att | Yes (1) | AuditedFinancialStmtAttInd |
| Grants To Organizations | 0 | GrantsToOrganizationsInd |
| Grants To Individuals | 0 | GrantsToIndividualsInd |
| Schedule J Required | Yes (1) | ScheduleJRequiredInd |
| Tax Exempt Bonds | Yes (1) | TaxExemptBondsInd |
| Invest Tax Exempt Bonds | 0 | InvestTaxExemptBondsInd |
| Escrow Account | 0 | EscrowAccountInd |
| On Behalf Of Issuer | 0 | OnBehalfOfIssuerInd |
| Engaged In Excess Benefit Trans | 0 | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | 0 | PYExcessBenefitTransInd |
| Loan Outstanding | 0 | LoanOutstandingInd |
| Grant To Related Person | 0 | GrantToRelatedPersonInd |
| Business Rln With Org Mem | 0 | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | 0 | BusinessRlnWithFamMemInd |
| Business Rln With Officer Ent | 0 | BusinessRlnWithOfficerEntInd |
| Deductible Non Cash Contri | 0 | DeductibleNonCashContriInd |
| Deductible Art Contribution | 0 | DeductibleArtContributionInd |
| Terminate Operations | 0 | TerminateOperationsInd |
| Partial Liquidation | 0 | PartialLiquidationInd |
| Disregarded Entity | 0 | DisregardedEntityInd |
| Related Entity | Yes (1) | RelatedEntityInd |
| Related Organization Ctrl Ent | Yes (1) | RelatedOrganizationCtrlEntInd |
| Transaction With Control Ent | 0 | TransactionWithControlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | 0 | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| IRP Document | 32 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (1) | BackupWthldComplianceInd |
| Employee | 137 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (1) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | 0 | UnrelatedBusIncmOverLimitInd |
| Foreign Financial Account | 0 | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | 0 | TaxablePartyNotificationInd |
| Nondeductible Contributions | 0 | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributionsInd |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOfInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | 0 | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | 0 | PayPremiumsPrsnlBnftCntrctInd |
| Indoor Tanning Services | 0 | IndoorTanningServicesInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 9 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 8 | IndependentVotingMemberCnt |
| Family Or Business Rln | 0 | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | 0 | DelegationOfMgmtDutiesInd |
| Change To Org Documents | 0 | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | Yes (1) | MembersOrStockholdersInd |
| Election Of Board Members | Yes (1) | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | 0 | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (1) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (1) | MinutesOfCommitteesInd |
| Officer Mailing Address | 0 | OfficerMailingAddressInd |
| Local Chapters | 0 | LocalChaptersInd |
| Form990 Provided To Gvrn Body | Yes (1) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (1) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (1) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (1) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | 0 | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (1) | DocumentRetentionPolicyInd |
| Compensation Process CEO | Yes (1) | CompensationProcessCEOInd |
| Compensation Process Other | Yes (1) | CompensationProcessOtherInd |
| Investment In Joint Venture | 0 | InvestmentInJointVentureInd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | ALAN O'NEIL | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 7013529365 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 164 WEST 13TH STREET | AddressLine1Txt |
| City | GRAFTON | CityNm |
| State Abbreviation | ND | StateAbbreviationCd |
| ZIP | 58257 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (16 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | OfficerOfficerInd | Highest Compensated EmployeeHighestCompensatedEmployeeInd |
|---|---|---|---|---|---|---|---|---|
| TOM CAMPBELL | ||||||||
| BOARD MEMBER | 1.50 | Yes (X) | $0 | $0 | $0 | |||
| RUSSELL CARIGNAN | ||||||||
| BOARD MEMBER | 1.50 | Yes (X) | $0 | $0 | $0 | |||
| ROGER GORDER | ||||||||
| BOARD MEMBER | 1.50 | Yes (X) | $0 | $0 | $0 | |||
| MARY HOUDEK | ||||||||
| BOARD MEMBER (THRU JANUARY) | 1.50 | Yes (X) | $0 | $0 | $0 | |||
| TODD MORGAN | ||||||||
| BOARD MEMBER | 1.50 | Yes (X) | $0 | $0 | $0 | |||
| DR JOSHUA OMOTUNDE | ||||||||
| BOARD MEMBER | 40.00 | Yes (X) | $274,463 | $0 | $25,639 | |||
| HEIDI PAULSON | ||||||||
| BOARD MEMBER | 1.50 | Yes (X) | $0 | $0 | $0 | |||
| JO PETERSON | ||||||||
| PRESIDENT | 2.00 | Yes (X) | $0 | $0 | $0 | 1.00 | Yes (X) | |
| PASTOR CHRIS GAULE | ||||||||
| VICE PRESIDENT | 2.00 | Yes (X) | $0 | $0 | $0 | Yes (X) | ||
| AMY VOLLRATH | ||||||||
| SECRETARY/TREASURER | 1.50 | Yes (X) | $0 | $0 | $0 | Yes (X) | ||
| ALAN O'NEIL | ||||||||
| CHIEF EXECUTIVE OFFICER | 40.00 | $159,994 | $0 | $2,859 | Yes (X) | |||
| RACHEL RAY | ||||||||
| CHIEF FINANCIAL OFFICER | 40.00 | $70,693 | $0 | $7,670 | Yes (X) | |||
| MIRIAM ANDERSON | ||||||||
| FAMILY NURSE PRACTITIONER | 40.00 | $153,911 | $0 | $17,285 | Yes (X) | |||
| DR LINDA FILLIPI | ||||||||
| PHYSICIAN | 40.00 | $139,298 | $0 | $10,214 | Yes (X) | |||
| MARCIA KETTERLING | ||||||||
| FAMILY NURSE PRACTITIONER | 40.00 | $166,200 | $0 | $14,988 | Yes (X) | |||
| DR ELIZABETH SUNDBERG | ||||||||
| PHYSICIAN | 40.00 | $170,719 | $0 | $12,145 | Yes (X) | |||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $1,135,278 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $0 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $90,800 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 6 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | 0 | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (1) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | 0 | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (4 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1Txt | CityContractorAddress/USAddress/CityNm | State AbbreviationContractorAddress/USAddress/StateAbbreviationCd | ZIPContractorAddress/USAddress/ZIPCd | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| DMS | |||||
| 26283 NETWORK PLACE | CHICAGO | IL | 60673 | MOBILE SERVICES | $312,815 |
| CRL | |||||
| 7505 | METROL BOULEVARD STE | MN | 55439 | RADIOLOGY READINGS | $130,471 |
| ALTRU | |||||
| PO BOX 13780 | GRAND FORKS | ND | 58208 | EPIC TELEPHARMACY | $115,221 |
| SIEMAN'S | |||||
| PO BOX 121102 | DALLAS | TX | 75312 | REAGENT TESTING SERVICES | $107,986 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 4 | CntrctRcvdGreaterThan100KCnt |
| Related Organizations | $41,695 | RelatedOrganizationsAmt |
| Government Grants | $346,742 | GovernmentGrantsAmt |
| All Other Contributions | $115,897 | AllOtherContributionsAmt |
| Total Contributions | $504,334 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (2 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| NET PATIENT SERVICE REVENUE | 621300 | $10,377,301 | $10,377,301 |
| OTHER MEDICAL SERVICES REVENUE | 621300 | $116,795 | $116,795 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $10,494,096 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $276 | TotalRevenueColumnAmt |
| Exclusion | $276 | ExclusionAmt |
Other Revenue Misc OtherRevenueMiscGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | EHR INCENTIVE REVENUE | Desc |
| Business | 621300 | BusinessCd |
| Total Revenue Column | $58,502 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $58,502 | RelatedOrExemptFuncIncomeAmt |
Miscellaneous Revenue MiscellaneousRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $55,673 | TotalRevenueColumnAmt |
| Exclusion | $55,673 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $114,175 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $11,112,881 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $10,552,598 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $55,949 | ExclusionAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $5,251,309 | TotalAmt |
| Program Services | $4,246,341 | ProgramServicesAmt |
| Management And General | $1,004,968 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $750 | TotalAmt |
| Management And General | $750 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $500,928 | TotalAmt |
| Program Services | $405,063 | ProgramServicesAmt |
| Management And General | $95,865 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $354,011 | TotalAmt |
| Program Services | $286,262 | ProgramServicesAmt |
| Management And General | $67,749 | ManagementAndGeneralAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $14,682 | TotalAmt |
| Management And General | $14,682 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $49,010 | TotalAmt |
| Management And General | $49,010 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $989,489 | TotalAmt |
| Program Services | $970,412 | ProgramServicesAmt |
| Management And General | $19,077 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $53,322 | TotalAmt |
| Management And General | $53,322 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $582,724 | TotalAmt |
| Program Services | $505,949 | ProgramServicesAmt |
| Management And General | $76,775 | ManagementAndGeneralAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $114,531 | TotalAmt |
| Management And General | $114,531 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $164,907 | TotalAmt |
| Program Services | $142,988 | ProgramServicesAmt |
| Management And General | $21,919 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $37,981 | TotalAmt |
| Program Services | $24,404 | ProgramServicesAmt |
| Management And General | $13,577 | ManagementAndGeneralAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $25 | TotalAmt |
| Management And General | $25 | ManagementAndGeneralAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $120,772 | TotalAmt |
| Program Services | $120,772 | ProgramServicesAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $339,051 | TotalAmt |
| Program Services | $293,985 | ProgramServicesAmt |
| Management And General | $45,066 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $104,297 | TotalAmt |
| Management And General | $104,297 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| MEDICAL SUPPLIES | $1,077,237 | $1,077,237 | |
| PROVISION FOR BAD DEBT | $541,125 | $541,125 | |
| COMMUNICATIONS | $100,360 | $33,245 | $67,115 |
| DUES AND SUBSCRIPTIONS | $25,698 | $13,383 | $12,315 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $35,935 | TotalAmt |
| Program Services | $30,060 | ProgramServicesAmt |
| Management And General | $5,875 | ManagementAndGeneralAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $10,458,144 | TotalAmt |
| Program Services | $8,691,226 | ProgramServicesAmt |
| Management And General | $1,766,918 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $180,694 | BOYAmt |
| EOY | $170,620 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $589,668 | BOYAmt |
| EOY | $969,557 | EOYAmt |
Pledges And Grants Receivable PledgesAndGrantsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,828,094 | BOYAmt |
| EOY | $0 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $1,775,283 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $117,184 | BOYAmt |
| EOY | $115,636 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $36,325 | BOYAmt |
| EOY | $51,311 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $10,627,410 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $8,388,806 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,334,301 | BOYAmt |
| EOY | $2,238,604 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $179,977 | BOYAmt |
| EOY | $195,222 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $5,266,243 | BOYAmt |
| EOY | $5,516,233 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $949,776 | BOYAmt |
| EOY | $623,993 | EOYAmt |
Tax Exempt Bond Liabilities TaxExemptBondLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,035,000 | BOYAmt |
| EOY | $1,937,150 | EOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $15,682 | BOYAmt |
| EOY | $34,568 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,000,458 | BOYAmt |
| EOY | $2,595,711 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,206,938 | BOYAmt |
| EOY | $2,861,675 | EOYAmt |
Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $58,847 | BOYAmt |
| EOY | $58,847 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,265,785 | BOYAmt |
| EOY | $2,920,522 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $5,266,243 | BOYAmt |
| EOY | $5,516,233 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | $654,737 | ReconcilationRevenueExpnssAmt |
| Other Changes In Net Assets | $0 | OtherChangesInNetAssetsAmt |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | 0 | AccountantCompileOrReviewInd |
| FS Audited | Yes (1) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Consolidated Basis Fincl Stmt | Yes (X) | ConsolidatedBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | Yes (1) | AuditCommitteeInd |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequiredInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital | Yes (X) | HospitalInd |
Schedule B IRS990ScheduleB
Contributor Information ContributorInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor | RESTRICTED | ContributorNum |
Contributor Business Name ContributorBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor US Address ContributorUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Contributions | RESTRICTED | TotalContributionsAmt |
Schedule C IRS990ScheduleC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Volunteers | 0 | VolunteersInd |
| Paid Staff Or Management | 0 | PaidStaffOrManagementInd |
| Media Advertisements | 0 | MediaAdvertisementsInd |
| Mailings Members | 0 | MailingsMembersInd |
| Publications Or Broadcast | 0 | PublicationsOrBroadcastInd |
| Grants Other Organizations | 0 | GrantsOtherOrganizationsInd |
| Direct Contact Legislators | 0 | DirectContactLegislatorsInd |
| Rallies Demonstrations | 0 | RalliesDemonstrationsInd |
| Other Activities | Yes (1) | OtherActivitiesInd |
| Other Activities | $1,882 | OtherActivitiesAmt |
| Total Lobbying Expenditures | $1,882 | TotalLobbyingExpendituresAmt |
| Not Described Section501c3 | 0 | NotDescribedSection501c3Ind |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART II-B, LINE 1: | FormAndLineReferenceDesc |
| Explanation | THE ORGANIZATION IS A MEMBER OF AMERICAN HOSPITAL ASSOCIATION, NORTH DAKOTA HOSPITAL ASSOCIATION, AND NORTH DAKOTA MEDICAL ASSOCIATION. A PORTION OF MEMBERSHIP DUES TO THE ABOVE LISTED ASSOCIATIONS IS USED FOR LOBBYING. THESE ASSOCIATIONS ADVOCATE ON BEHALF OF ITS MEMBERS FOR IMPROVING EFFICIENCY AND ACCESSIBILITY OF THE HEALTHCARE DELIVERY SYSTEMS AND THE HEALTH STATUS OF NORTH DAKOTA'S POPULATION. | ExplanationTxt |
Schedule D IRS990ScheduleD
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $43,017 | OtherCostOrOtherBasisAmt |
| Book Value | $43,017 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $7,784,594 | OtherCostOrOtherBasisAmt |
| Depreciation | $6,001,546 | DepreciationAmt |
| Book Value | $1,783,048 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $2,778,310 | OtherCostOrOtherBasisAmt |
| Depreciation | $2,387,260 | DepreciationAmt |
| Book Value | $391,050 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $21,489 | OtherCostOrOtherBasisAmt |
| Book Value | $21,489 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $2,238,604 | TotalBookValueLandBuildingsAmt |
| Total Rev Etc Audited Fincl Stmt | $10,571,756 | TotalRevEtcAuditedFinclStmtAmt |
| Revenue Not Reported | $0 | RevenueNotReportedAmt |
| Revenue Subtotal | $10,571,756 | RevenueSubtotalAmt |
| Other Revenues Not Included | $541,125 | OtherRevenuesNotIncludedAmt |
| Revenue Not Reported Fincl Stmt | $541,125 | RevenueNotReportedFinclStmtAmt |
| Total Revenue Per Form990 | $11,112,881 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $9,917,019 | TotExpnsEtcAuditedFinclStmtAmt |
| Expenses Not Reported | $0 | ExpensesNotReportedAmt |
| Expenses Subtotal | $9,917,019 | ExpensesSubtotalAmt |
| Other Expenses Not Included | $541,125 | OtherExpensesNotIncludedAmt |
| Expenses Not Rpt Fincl Stmt | $541,125 | ExpensesNotRptFinclStmtAmt |
| Total Expenses Per Form990 | $10,458,144 | TotalExpensesPerForm990Amt |
Supplemental Information Detail SupplementalInformationDetail (2 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART XI, LINE 4B - OTHER ADJUSTMENTS: | PROVISION FOR BAD DEBT 541,125. |
| PART XII, LINE 4B - OTHER ADJUSTMENTS: | PROVISION FOR BAD DEBT 541,125. |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Assistance Policy | Yes (1) | FinancialAssistancePolicyInd |
| Written Policy | Yes (1) | WrittenPolicyInd |
| All Hospitals Policy | Yes (X) | AllHospitalsPolicyInd |
| FPG Reference Free Care | Yes (1) | FPGReferenceFreeCareInd |
| Percent100 | Yes (X) | Percent100Ind |
| FPG Reference Discounted Care | Yes (1) | FPGReferenceDiscountedCareInd |
| Percent200 D | Yes (X) | Percent200DInd |
| Free Care Medically Indigent | Yes (1) | FreeCareMedicallyIndigentInd |
| Financial Assistance Budget | Yes (1) | FinancialAssistanceBudgetInd |
| Expenses Exceed Budget | Yes (1) | ExpensesExceedBudgetInd |
| Unable To Provide Care | 0 | UnableToProvideCareInd |
| Annual Community Bnft Report | 0 | AnnualCommunityBnftReportInd |
Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $44,258 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $44,258 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00450 | TotalExpensePct |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $714,016 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $646,527 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $67,489 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00680 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $758,274 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $646,527 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $111,747 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.01130 | TotalExpensePct |
Community Health Services CommunityHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $2,500 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $2,500 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00030 | TotalExpensePct |
Subsidized Health Services SubsidizedHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $3,121,720 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $2,930,757 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $190,963 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.01930 | TotalExpensePct |
Total Other Benefits TotalOtherBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $3,124,220 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $2,930,757 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $193,463 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.01960 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $3,882,494 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $3,577,284 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $305,210 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.03090 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | 0 | BadDebtExpenseReportedInd |
| Bad Debt Expense | $397,349 | BadDebtExpenseAmt |
| Bad Debt Expense Attributable | $39,735 | BadDebtExpenseAttributableAmt |
| Reimbursed By Medicare | $4,851,527 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $5,636,750 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | -$785,223 | MedicareSurplusOrShortfallAmt |
Costing Methodology Used CostingMethodologyUsedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cost To Charge Ratio | Yes (X) | CostToChargeRatioInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | Yes (1) | WrittenDebtCollectionPolicyInd |
| Financial Assistance Prvsn | Yes (1) | FinancialAssistancePrvsnInd |
| Hospital Facilities | 1 | HospitalFacilitiesCnt |
Hospital Facilities HospitalFacilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CHRISTIAN UNITY HOSPITAL CORPORATION | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 164 WEST 13TH STREET | AddressLine1Txt |
| City | GRAFTON | CityNm |
| State Abbreviation | ND | StateAbbreviationCd |
| ZIP | 58257 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Website Address | WWW.UNITYMEDICALCENTER.COM | WebsiteAddressTxt |
| State License | 5020 | StateLicenseNum |
| Licensed Hospital | Yes (X) | LicensedHospitalInd |
| General Medical And Surgical | Yes (X) | GeneralMedicalAndSurgicalInd |
| Critical Access Hospital | Yes (X) | CriticalAccessHospitalInd |
| Emergency Room24 Hrs | Yes (X) | EmergencyRoom24HrsInd |
| Other | RURAL HOSPITAL | OtherDesc |
Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CHRISTIAN UNITY HOSPITAL CORPORATION | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
| First Licensed CY Or PY | 0 | FirstLicensedCYOrPYInd |
| Tax Exempt Hospital CY Or PY | 0 | TaxExemptHospitalCYOrPYInd |
| CHNA Conducted | Yes (1) | CHNAConductedInd |
| Community Definition | Yes (X) | CommunityDefinitionInd |
| Community Demographics | Yes (X) | CommunityDemographicsInd |
| Existing Resources | Yes (X) | ExistingResourcesInd |
| How Data Obtained | Yes (X) | HowDataObtainedInd |
| Community Health Needs | Yes (X) | CommunityHealthNeedsInd |
| Other Health Issues | Yes (X) | OtherHealthIssuesInd |
| Community Hlth Needs Id Process | Yes (X) | CommunityHlthNeedsIdProcessInd |
| Consulting Process | Yes (X) | ConsultingProcessInd |
| Information Gaps | Yes (X) | InformationGapsInd |
| CHNA Conducted | 15 | CHNAConductedYr |
| Take Into Account Others Input | Yes (1) | TakeIntoAccountOthersInputInd |
| CHNA Conducted With Other Fclts | Yes (1) | CHNAConductedWithOtherFcltsInd |
| CHNA Conducted With Non Fclts | Yes (1) | CHNAConductedWithNonFcltsInd |
| CHNA Report Widely Available | Yes (1) | CHNAReportWidelyAvailableInd |
| Rpt Available On Own Website | Yes (X) | RptAvailableOnOwnWebsiteInd |
| Own Website URL | SEE SUPPLEMENTAL INFORMATION | OwnWebsiteURLTxt |
| Paper Copy Public Inspection | Yes (X) | PaperCopyPublicInspectionInd |
| Implementation Strategy Adopt | Yes (1) | ImplementationStrategyAdoptInd |
| Implementation Strategy Adpt | 15 | ImplementationStrategyAdptYr |
| Strategy Posted Website | Yes (1) | StrategyPostedWebsiteInd |
| Strategy Website URL | SEE SUPPLEMENTAL INFORMATION | StrategyWebsiteURLTxt |
| Strategy Attached | Yes (1) | StrategyAttachedInd |
| Organization Incur Excise Tax | 0 | OrganizationIncurExciseTaxInd |
| Elig Criteria Explained | Yes (1) | EligCriteriaExplainedInd |
| FPG Family Incm Lmt Free Dscnt | Yes (X) | FPGFamilyIncmLmtFreeDscntInd |
| FPG Family Incm Lmt Free Care | 100.000000000000 | FPGFamilyIncmLmtFreeCarePct |
| FPG Family Incm Lmt Dscnt Care | 200.000000000000 | FPGFamilyIncmLmtDscntCarePct |
| Income Level Criteria | Yes (X) | IncomeLevelCriteriaInd |
| Explained Basis | Yes (1) | ExplainedBasisInd |
| App Financial Asst Expln | Yes (1) | AppFinancialAsstExplnInd |
| Described Info | Yes (X) | DescribedInfoInd |
| Described Suprt Doc | Yes (X) | DescribedSuprtDocInd |
| Provided Hospital Contact | Yes (X) | ProvidedHospitalContactInd |
| Provided Nonprofit Contact | Yes (X) | ProvidedNonprofitContactInd |
| Other Method | Yes (X) | OtherMethodInd |
| Includes Publicity Measures | Yes (1) | IncludesPublicityMeasuresInd |
| FAP Available On Website | Yes (X) | FAPAvailableOnWebsiteInd |
| FAP Available On Website URL | SEE PART V, PAGE 7 | FAPAvailableOnWebsiteURLTxt |
| FAP App Available On Website | Yes (X) | FAPAppAvailableOnWebsiteInd |
| FAP App Available On Website URL | SEE PART V, PAGE 7 | FAPAppAvailableOnWebsiteURLTxt |
| FAP Summary On Website | Yes (X) | FAPSummaryOnWebsiteInd |
| FAP Summary On Website URL | SEE PART V, PAGE 7 | FAPSummaryOnWebsiteURLTxt |
| FAP Avlbl On Request No Charge | Yes (X) | FAPAvlblOnRequestNoChargeInd |
| FAP App Avlbl On Request No Chrg | Yes (X) | FAPAppAvlblOnRequestNoChrgInd |
| FAP Sum Avlbl On Request No Chrg | Yes (X) | FAPSumAvlblOnRequestNoChrgInd |
| FAP Notice Displayed | Yes (X) | FAPNoticeDisplayedInd |
| Communtity Notified FAP | Yes (X) | CommuntityNotifiedFAPInd |
| FAP Actions On Nonpayment | Yes (1) | FAPActionsOnNonpaymentInd |
| Permit No Actions | Yes (X) | PermitNoActionsInd |
| Collection Activities | 0 | CollectionActivitiesInd |
| FAP Notified Upon Admission | Yes (X) | FAPNotifiedUponAdmissionInd |
| FAP Notified Before Discharge | Yes (X) | FAPNotifiedBeforeDischargeInd |
| FAP Notified All Patients | Yes (X) | FAPNotifiedAllPatientsInd |
| Documented Elig Determination | Yes (X) | DocumentedEligDeterminationInd |
| Other Actions Taken | Yes (X) | OtherActionsTakenInd |
| Nondis Emergency Care Policy | Yes (1) | NondisEmergencyCarePolicyInd |
| Other Method Used | Yes (X) | OtherMethodUsedInd |
| Amounts Generally Billed | 0 | AmountsGenerallyBilledInd |
| Gross Charges | 0 | GrossChargesInd |
Supplemental Information SupplementalInformationGrp (7 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| CHRISTIAN UNITY HOSPITAL CORPORATION | PART V, SECTION B, LINE 5: ONE-ON-ONE INTERVIEWS WITH EIGHT KEY INFORMANTS WERE CONDUCTED IN PERSON IN GRAFTON ON MARCH 16TH OR BY PHONE FOR THOSE UNAVAILABLE. A REPRESENTATIVE FROM THE CENTER FOR RURAL HEALTH CONDUCTED THE INTERVIEWS. INTERVIEWS WERE HELD WITH SELECTED MEMBERS OF THE COMMUNITY GROUP AS WELL AS OTHER KEY INFORMANTS WHO COULD PROVIDE INSIGHTS INTO THE COMMUNITY'S HEALTH NEEDS. INCLUDED AMONG THE INFORMANTS WERE PUBLIC HEALTH PROFESSIONALS WITH SPECIAL KNOWLEDGE IN PUBLIC HEALTH ACQUIRED THROUGH SEVERAL YEARS OF DIRECT EXPERIENCE IN THE COMMUNITY, INCLUDING WORKING WITH MEDICALLY UNDERSERVED, LOW INCOME, AND MINORITY POPULATIONS, AS WELL AS WITH POPULATIONS WITH CHRONIC DISEASES.TOPICS COVERED DURING THE INTERVIEWS INCLUDED THE GENERAL HEALTH NEEDS OF THE COMMUNITY, THE GENERAL HEALTH OF THE COMMUNITY, COMMUNITY CONCERNS, DELIVERY OF HEALTH CARE BY LOCAL PROVIDERS, AWARENESS OF HEALTH SERVICES OFFERED LOCALLY, BARRIERS TO RECEIVING HEALTH SERVICES, AND SUGGESTIONS FOR IMPROVING COLLABORATION WITHIN THE COMMUNITY. A SURVEY WAS DISTRIBUTED TO GATHER FEEDBACK FROM THE COMMUNITY. THE SURVEY WAS NOT INTENDED TO BE A SCIENTIFIC OR STATISTICALLY VALID SAMPLING OF THE POPULATION. RATHER, IT WAS DESIGNED TO BE AN ADDITIONAL TOOL FOR COLLECTING QUALITATIVE DATA FROM THE COMMUNITY AT LARGE SPECIFICALLY; INFORMATION RELATED TO COMMUNITY-PERCEIVED HEALTH NEEDS. A COPY OF THE SURVEY INSTRUMENT IS INCLUDED IN APPENDIX A.THE COMMUNITY MEMBER SURVEY WAS DISTRIBUTED TO A VARIETY OF RESIDENTS OF WALSH COUNTY, AND WAS DESIGNED TO: -LEARN OF THE GOOD THINGS IN THE COMMUNITY AND THE COMMUNITY'S CONCERNS; -UNDERSTAND PERCEPTIONS AND ATTITUDES ABOUT THE HEALTH OF THE COMMUNITY, AND HEAR SUGGESTIONS FOR IMPROVEMENT; AND -LEARN MORE ABOUT HOW LOCAL HEALTH SERVICES ARE USED BY RESIDENTS. SPECIFICALLY, THE SURVEY COVERED THE FOLLOWING TOPICS: RESIDENTS' PERCEPTIONS ABOUT COMMUNITY ASSETS, LEVELS OF COLLABORATION WITHIN THE COMMUNITY, BROAD AREAS OF COMMUNITY AND HEALTH CONCERNS, NEED FOR HEALTH SERVICES, CONCERNS ABOUT THE DELIVERY OF HEALTH CARE IN THE COMMUNITY, BARRIERS TO USING LOCAL HEALTH CARE, PREFERENCES FOR USING LOCAL HEALTH CARE VERSUS TRAVELING TO OTHER FACILITIES, USE OF PREVENTIVE CARE, USE OF PUBLIC HEALTH SERVICES, SUGGESTIONS TO IMPROVE COMMUNITY HEALTH, AND BASIC DEMOGRAPHIC INFORMATION. TO PROMOTE AWARENESS OF THE ASSESSMENT PROCESS, PRESS RELEASES LED TO PUBLISHED ARTICLES IN FOUR NEWSPAPERS IN WALSH COUNTY INCLUDING IN THE COMMUNITIES OF GRAFTON, PARK RIVER, FORDVILLE, EDMORE, AND ADAMS. ADDITIONALLY, INFORMATION WAS PUBLISHED IN THE WALSH COUNTY HEALTH DISTRICT NEWSLETTER AND ON THE UMC AND WCHD WEBSITES AND ON KXPO RADIO IN GRAFTON. APPROXIMATELY 1,000 COMMUNITY MEMBER SURVEYS WERE AVAILABLE FOR DISTRIBUTION IN WALSH COUNTY. THE SURVEYS WERE DISTRIBUTED BY COMMUNITY GROUP MEMBERS AND AT UNITY MEDICAL CENTER, FIRST CARE HEALTH CENTER, WALSH COUNTY HEALTH AND WIC, BANKS, SENIOR CITIZEN MEAL SITES, NURSING HOMES, THE COURTHOUSE, AND AREA BUSINESS OFFICES. TO HELP ENSURE ANONYMITY, INCLUDED WITH EACH SURVEY WAS A POSTAGE-PAID RETURN ENVELOPE TO THE CENTER FOR RURAL HEALTH. IN ORDER TO MAKE THE SURVEY AVAILABLE AS WIDELY AS POSSIBLE RESIDENTS COULD ALSO REQUEST A SURVEY BY CALLING WALSH COUNTY HEALTH DISTRICT, UNITY MEDICAL CENTER OR FIRST CARE HEALTH CENTER. THE SURVEY WAS OPEN FROM FEBRUARY 22, 2016 TO MARCH 30, 2016; 444 PAPER SURVEYS WERE RETURNED. |
| CHRISTIAN UNITY HOSPITAL CORPORATION | PART V, SECTION B, LINE 6A: FIRST CARE HEALTH CENTER |
| CHRISTIAN UNITY HOSPITAL CORPORATION | PART V, SECTION B, LINE 6B: WALSH COUNTY PUBLIC HEALTH |
| CHRISTIAN UNITY HOSPITAL CORPORATION | PART V, SECTION B, LINE 11: SEE PAGE 49 OF THE ATTACHED 2016 CHNA. WEBSITE ADDRESS FOR CHNA AND IMPLEMENTATION STRATEGY:WWW.UNITYMEDCENTER.COM/ABOUT-US/HIPAA.HTML |
| CHRISTIAN UNITY HOSPITAL CORPORATION | PART V, SECTION B, LINE 15E: PATIENTS WHO DO NOT PAY AFTER 90 DAYS MEET WITH THE PATIENT ACCOUNT REPRESENTATIVE AND GO OVER THEIR AVAILABLE OPTIONS INCLUDING FINANCIAL ASSISTANCE. THE ORGANIZATION POSTS THE EMTALA LAW IN THEIR EMERGENCY ROOM. THE ORGANIZATION IS ALSO WEIGHING THEIR OPTIONS OF HOW TO MAKE THEIR FINANCIAL ASSISTANCE POLICY MORE WIDELY AVAILABLE TO THE PUBLIC INCLUDING THE POSSIBILITY OF POSTING THE POLICY ON THEIR WEBSITE. |
| CHRISTIAN UNITY HOSPITAL CORPORATION | PART V, SECTION B, LINE 16I: FAP WWW.UNITYMEDCENTER.COM/ABOUT-US/HIPAA.HTMLFAP APPLICATIONWWW.UNITYMEDCENTER.COM/ABOUT-US/HIPAA.HTMLFAP PLAIN LANGUAGE SUMMARYWWW.UNITYMEDCENTER.COM/ABOUT-US/HIPAA.HTML |
| CHRISTIAN UNITY HOSPITAL CORPORATION | PART V, SECTION B, LINE 22D: THE ORGANIZATION USED THE "LOOK-BACK METHOD" USING A COMBINATION OF MEDICARE, MEDICAID, AND PRIVATE INSURERS TO DETERMINE AMOUNTS GENERALLY BILLED. |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
Oth Hlth Care Fclts Not Hospital OthHlthCareFcltsNotHospitalGrp
Oth Hlth Care Fclts OthHlthCareFcltsGrp
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | 1 - GRAFTON FAMILY CLINIC | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 155 WEST 14TH STREET | AddressLine1Txt |
| City | GRAFTON | CityNm |
| State Abbreviation | ND | StateAbbreviationCd |
| ZIP | 58257 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | RURAL HEALTH CLINIC | FacilityTxt |
Supplemental Information Detail SupplementalInformationDetail (14 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART I, LINE 3C: | THE ORGANIZATION DOES FOLLOW THE FEDERAL POVERTY GUIDELINES (FPG) WHEN DETERMINING DISCOUNTED CARE, BUT THEY HAVE SET UP THREE DIFFERENT RANGES WITHIN THE GUIDELINES. A PATIENT WILL PAY 30%, 60% OR 80% OF THEIR BILL DEPENDING UPON WHERE THEIR INCOME FALLS. THE PATIENT IS RESPONSIBLE FOR 30% OF THEIR BILL IF THEIR INCOME IS 100% TO 132% OF THE FPG. THE PATIENT IS RESPONSIBLE FOR 60% OF THEIR BILL IF THEIR INCOME FALLS BETWEEN 133% TO 166% OF THE FPG. THE PATIENT IS RESPONSIBLE FOR 80% OF THEIR BILL IF THEIR INCOME FALLS BETWEEN 167% AND 200% OF THE FPG. IF THE INDIVIDUAL FALLS BELOW THE MINIMUM CRITERIA, THAT PERSON IS ELIGIBLE FOR 100% CHARITY CARE ALLOWANCE, OR FREE CARE. |
| PART I, LINE 7: | THE ORGANIZATION USES THE MEDICARE COST REPORT IN DETERMINING THE COST-TO-CHARGE RATIO. |
| PART I, LINE 7G: | AMOUNTS USED FOR SUBSIDIZED SERVICES WERE CALCULATED USING DETAILED REPORT DATA KEPT BY THE ORGANIZATION. THE ORGANIZATION INCLUDED DATA FOR EMERGENCY SERVICES AND THEIR RURAL HEALTH CLINIC IN LINE 7G. THE AMOUNTS FOR RURAL HEALTH CLINIC WAS A COST OF 1,906,664 WITH OFFSETTING REVENUE OF 1,852,610. SUBSIDIZED SERVICES ARE DETERMINED BY THE ORGANIZATION DUE TO THE NEED IN THE COMMUNITY THAT CAN ONLY BE FILLED BY THE ORGANIZATION. |
| 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 $ 541,125. |
| PART III, LINE 2: | THIS AMOUNT IS CALCULATED BY MULTIPLYING THE TOTAL CHARGES FOR SERVICES WRITTEN OFF AS BAD DEBT BY THE COST TO CHARGE RATIO. |
| PART III, LINE 3: | 9.9% OF THE INDIVIDUALS IN WALSH COUNTY, NORTH DAKOTA (IN WHICH THE HOSPITAL IS LOCATED) FALL BELOW THE FEDERAL POVERTY LEVELS ACCORDING TO CENSUS.GOV. THEREFORE, THE ORGANIZATION ESTIMATES THAT 9.9% OF THE BAD DEBT EXPENSE AT COST IS ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER THE ORGANIZATION'S CHARITY CARE POLICY. CARE IS GIVEN TO INDIVIDUALS REGARDLESS OF THEIR ABILITY TO PAY AND SO THEREFORE THIS IS A COMMUNITY BENEFIT. |
| PART III, LINE 4: | MANAGEMENT PROVIDES FOR PROBABLE UNCOLLECTIBLE AMOUNTS, PRIMARILY FOR UNINSURED PATIENTS AND AMOUNTS PATIENTS ARE PERSONALLY RESPONSIBLE FOR, THROUGH A REDUCTION OF GROSS REVENUE AND A CREDIT TO THE ALLOWANCE FOR DOUBTFUL ACCOUNTS.FINANCIAL STATEMENT FOOTNOTE 3 ACCOUNTS RECEIVABLE:THE ORGANIZATION'S ALLOWANCE FOR DOUBTFUL ACCOUNTS FOR SELF-PAY PATIENTS DECREASED FROM 70% OF SELF-PAY ACCOUNTS RECEIVABLE AT JUNE 30, 2015, TO 68% SELF-PAY ACCOUNTS RECEIVABLE AT JUNE 30, 2016. THE ORGANIZATION DOES NOT MAINTAIN A MATERIAL ALLOWANCE FOR DOUBTFUL ACCOUNTS FROM THIRD-PARTY PAYERS, NOR DID IT HAVE SIGNIFICANT WRITE-OFFS FROM THIRD-PARTY PAYERS. THE ORGANIZATION HAS NOT SIGNIFICANTLY CHANGED ITS CHARITY CARE OR UNINSURED DISCOUNT POLICIES DURING FISCAL YEARS 2016 OR 2015. |
| PART III, LINE 8: | MEDICARE ALLOWABLE COSTS OF CARE ARE BASED ON THE MEDICARE COST REPORT. THE MEDICARE COST REPORT IS COMPLETED BASED ON THE RULES AND REGULATIONS SET FORTH BY CENTERS FOR MEDICARE AND MEDICAID SERVICES.CHRISTIAN UNITY HOSPITAL CORPORATION PROVIDES MEDICALLY NECESSARY CARE TO ALL REGARDLESS OF THE ABILITY TO PAY. PROVIDING SERVICES TO THOSE ELIGIBLE FOR MEDICARE IS A BENEFIT TO THE COMMUNITY AS ELDERLY ARE A CHARITABLE CLASS. THEREFORE ALL OF THE SHORTFALL SHOULD BE TREATED AS A COMMUNITY BENEFIT. |
| PART III, LINE 9B: | IF AN INCOMPLETE FINANCIAL ASSISTANCE APPLICATION HAS BEEN SUBMITTED, THE PATIENT ACCOUNTS REPRESENTATIVE WILL WORK WITH THE PATIENT TO GATHER ANY MISSING OR OUTSTANDING ITEMS. ANY COLLECTION ACTIONS ARE STOPPED AFTER THE PATIENT SUBMITS AN APPLICATION FOR FINANCIAL ASSISTANCE UNTIL IT IS DETERMINED WHETHER OR NOT THE INDIVIDUAL IS ELIGIBLE FOR FINANCIAL ASSISTANCE. IF THE PATIENT QUALIFIES FOR FINANCIAL ASSISTANCE, ANY COLLECTION ACTIONS ALREADY TAKEN AGAINST THE INDIVIDUAL WOULD BE REVERSED. THE PATIENT ACCOUNTS REPRESENTATIVE DOCUMENTS WHETHER OR NOT THE INDIVIDUAL IS ELIGIBLE FOR FINANCIAL ASSISTANCE. |
| PART VI, LINE 2: | THROUGHOUT THE YEAR THE ORGANIZATION IS PROACTIVE IN DETERMINING WHAT NEEDS THEY CAN ADDRESS FOR THEIR COMMUNITY. IN BETWEEN CHNA'S THE ORGANIZATION CAN DETERMINE AREAS THAT THEY CAN ADDRESS. SOME EXAMPLES OF THESE AREAS ARE THE ORGANIZATION OBTAINED SERVICES FROM AN OUTREACH PODIATRIST. THE ORGANIZATION PURCHASED EQUIPMENT FOR HIM TO BE ABLE TO PERFORM SURGERIES IN OUR FACILITY, AS WELL AS SEE CLINIC PATIENTS. THE ORGANIZATION ALSO HAS DERMATOLOGY SERVICES AVAILABLE IN THEIR RURAL HEALTH CLINIC SEVERAL TIMES PER MONTH. THIS HAS BEEN VERY SUCCESSFUL. |
| PART VI, LINE 3: | A SIGN NEAR THE ENTRANCE TO THE EMERGENCY ROOM INDICATES WE "PROVIDE MEDICAL CARE FOR THOSE WHO CANNOT AFFORD TO PAY." ANOTHER POSTING STATES THAT "THE FACILITY IS LEGALLY OBLIGATED TO SERVE THE COMMUNITY." FOR THOSE PATIENTS WHO DO NOT PAY ON THEIR BALANCES, WE CONTACT THEM BY PHONE AND/OR THROUGH THE MAIL. THEY VISIT WITH OUR PATIENT ACCOUNT REPRESENTATIVE. THE REPRESENTATIVE DISCUSSES PAYMENT ARRANGEMENTS, ELIGIBILITY FOR CERTAIN PROGRAMS, SUCH AS MEDICAID, AND THEN CHARITY CARE, IF NECESSARY. IF WE CANNOT GET THOSE PATIENTS TO COME IN AND TALK, WE ATTEMPT TO MAKE ARRANGEMENTS OVER THE PHONE AND THROUGH THE MAIL, IF NECESSARY. WE DO HAVE SEVERAL PATIENTS WHO WILL NOT EVEN ATTEMPT TO COMPLETE FINANCIAL ASSISTANCE PAPERWORK. |
| PART VI, LINE 4: | GRAFTON IS A RURAL COMMUNITY OF APPROXIMATELY 4,284 RESIDENTS LOCATED IN WALSH COUNTY, NORTH DAKOTA. THE MEDIAN HOUSEHOLD INCOME FOR WALSH COUNTY IS $49,780, BELOW THE STATE AVERAGE OF $55,579. 9.9% OF INDIVIDUALS IN THE WALSH COUNTY FALL BELOW THE POVERTY LEVEL. UNITY MEDICAL CENTER SERVES THE POPULATION OF GRAFTON AND SEVERAL SURROUNDING SMALLER COMMUNITIES. THE AREA IS ALSO SERVED BY A HOSPITAL IN PARK RIVER AND A HOSPITAL IN GRAND FORKS. APPROXIMATELY 6% OF THE HOSPITAL'S BUSINESS IN FY 2016 WAS TO PRIVATE PAY INDIVIDUALS. APPROXIMATELY 4% OF OUR BUSINESS WAS TO MEDICAID RECIPIENTS. WE ALSO HAVE A MIGRANT HEALTH OFFICE LOCATED IN OUR COMMUNITY TO SERVE MIGRANTS. |
| PART VI, LINE 5: | THE UNITY MEDICAL CENTER (UMC) GOVERNING BODY IS COMPRISED OF PERSONS WHO RESIDE IN OUR PRIMARY SERVICE AREA. THE BOARD MEMBERS ARE NEITHER CONTRACTORS, OR FAMILY MEMBERS OF THE ORGANIZATION. MEDICAL STAFF PRIVILEGES ARE EXTENDED TO THOSE QUALIFIED PHYSICIANS IN OUR COMMUNITY WHO HAVE APPLIED FOR AND BEEN GRANTED MEDICAL PRIVILEGES, PER OUR CREDENTIALING PROCESS. SURPLUS FUNDS, WHEN AVAILABLE, ARE USED TO PURCHASE EQUIPMENT OR MAKE PURCHASES TO IMPROVE THE BUILDING STRUCTURE FOR THE PURPOSE OF IMPROVING PATIENT CARE OR FOR THE RETENTION OF QUALITY EMPLOYEES. UNITY MEDICAL CENTER FOUNDATION ALSO ASSISTS THE HOSPITAL WITH CAPITAL PURCHASES.UMC OFFERS 24 HOUR ACCESS TO EMERGENCY ROOM CARE, WHICH IS AVAILABLE TO ALL INDIVIDUALS, REGARDLESS OF THEIR ABILITY TO PAY FOR THE CARE. UMC OFFERS ACUTE CARE, SWING BED CARE, GENERAL SURGERY, AS WELL AS MANY OUTPATIENT SERVICES. UMC DOES PARTICIPATE IN EDUCATION OF HEALTHCARE PROFESSIONALS. WE TAKE APPROXIMATELY 2-3 MEDICAL STUDENTS PER YEAR AND SEVERAL PHYSICAL THERAPY STUDENTS THROUGHOUT THE YEAR FROM THE UNIVERSITY OF NORTH DAKOTA. WE DO TRAINING FOR STUDENTS FROM TECHNICAL SCHOOLS, AS WELL, AS REQUESTED. UMC IS THE ONLY HOSPITAL AND CLINIC IN THE COMMUNITY; THEREFORE, WE ARE A VIABLE PART OF THIS COMMUNITY. UMC OFFERS PROGRAMS SUCH AS DIABETES SCREENINGS, FLU VACCINATION CLINICS, FREE BLOOD PRESSURE CHECKS, EDUCATIONAL EVENTS FOR CENTURY ELEMENTARY STUDENTS AND WALSH COUNTY HEAD START STUDENTS, ETC. UMC ALSO HAS REPRESENTATIVE ON THE WALSH COUNTY WELLNESS COALITION COMMITTEE. UMC BRINGS IN SPECIALTY DOCTORS TO OUR CLINIC IN ORDER TO OFFER NECESSARY SERVICES TO OUR PATIENT POPULATION, I.E. ONCOLOGY, PSYCHIATRY, OBSTETRICS, ETC. WE OFFER VOLUNTEER OPPORTUNITIES FOR HIGH SCHOOL STUDENTS AND ADULTS. WE HAVE FOURTEEN MEMBERS OF OUR UMC AUXILIARY SERVICES THAT VOLUNTEER HERE EVERY WEEK FOR THE BENEFIT OF THE FACILITY. |
| PART VI, LINE 6: | N/A |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Compensation Survey | Yes (X) | CompensationSurveyInd |
| Board Or Committee Approval | Yes (X) | BoardOrCommitteeApprovalInd |
| Severance Payment | 0 | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | 0 | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | 0 | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | Yes (1) | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | 0 | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | 0 | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | 0 | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | 0 | AnyNonFixedPaymentsInd |
| Initial Contract Exception | 0 | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (5 entries)
| TitleTitleTxt | Base Compensation Filing OrgBaseCompensationFilingOrgAmt | Compensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmt | Bonus Filing OrganizationBonusFilingOrganizationAmount | Bonus Related OrganizationsBonusRelatedOrganizationsAmt | Other Compensation Filing OrgOtherCompensationFilingOrgAmt | Other Compensation Rltd OrgsOtherCompensationRltdOrgsAmt | Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt | Deferred Comp Rltd OrgsDeferredCompRltdOrgsAmt | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt | Nontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmt | Total Compensation Filing OrgTotalCompensationFilingOrgAmt | Total Compensation Rltd OrgsTotalCompensationRltdOrgsAmt | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmt | Comp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| DR JOSHUA OMOTUNDE | ||||||||||||||
| BOARD MEMBER | $131,868 | $0 | $142,595 | $0 | $0 | $0 | $0 | $0 | $25,639 | $0 | $300,102 | $0 | $0 | $0 |
| ALAN O'NEIL | ||||||||||||||
| CHIEF EXECUTIVE OFFICER | $159,994 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $2,859 | $0 | $162,853 | $0 | $0 | $0 |
| MIRIAM ANDERSON | ||||||||||||||
| FAMILY NURSE PRACTITIONER | $153,911 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $17,285 | $0 | $171,196 | $0 | $0 | $0 |
| MARCIA KETTERLING | ||||||||||||||
| FAMILY NURSE PRACTITIONER | $166,200 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $14,988 | $0 | $181,188 | $0 | $0 | $0 |
| DR ELIZABETH SUNDBERG | ||||||||||||||
| PHYSICIAN | $170,719 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $12,145 | $0 | $182,864 | $0 | $0 | $0 |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART I, LINE 5 | FormAndLineReferenceDesc |
| Explanation | PHYSICIAN COMPENSATION IS CALCULATED MONTHLY. PHYSICIANS EARN 58 PERCENT OF GROSS REVENUES FROM GROSS PROFESSIONAL CHARGES. | ExplanationTxt |
Schedule K IRS990ScheduleK
Tax Exempt Bonds Issues TaxExemptBondsIssuesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
Issuer Name IssuerName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CITY OF GRAFTON | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Issuer EIN | 456002080 | BondIssuerEIN |
| CUSIP | 384455BF7 | CUSIPNum |
| Bond Issued | 2008-04-23 | BondIssuedDt |
| Issue Price | $2,363,560 | IssuePriceAmt |
| Purpose | CAPITAL IMPROVEMENTS TO THE HOSPITAL | PurposeDesc |
| Defeased | 0 | DefeasedInd |
| On Behalf Of Issuer | 0 | OnBehalfOfIssuerInd |
| Pool Financing | 0 | PoolFinancingInd |
Tax Exempt Bonds Proceeds TaxExemptBondsProceedsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Retired | $378,560 | RetiredAmt |
| Total Proceeds | $2,363,560 | TotalProceedsAmt |
| Issuance Costs From Proceeds | $47,000 | IssuanceCostsFromProceedsAmt |
| Capital Expenditures | $2,316,560 | CapitalExpendituresAmt |
| Substantial Completion | 2009 | SubstantialCompletionYr |
| Current Refunding | 0 | CurrentRefundingInd |
| Advance Refunding | 0 | AdvanceRefundingInd |
| Final Allocation Made | Yes (1) | FinalAllocationMadeInd |
| Adequate Books And Rec Maint | Yes (1) | AdequateBooksAndRecMaintInd |
Tax Exempt Bonds Private Bus Use TaxExemptBondsPrivateBusUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Owning Bond Financed Property | 0 | OwningBondFinancedPropertyInd |
| Any Lease Arrangements | 0 | AnyLeaseArrangementsInd |
| Mgmt Contract Bond Fincd Prop | 0 | MgmtContractBondFincdPropInd |
| Any Research Agreements | 0 | AnyResearchAgreementsInd |
| Private Bus Use By Others | 0.00000 | PrivateBusUseByOthersPct |
| Private Bus Concerning UBI | 0.00000 | PrivateBusConcerningUBIPct |
| Total Private Business Use | 0.00000 | TotalPrivateBusinessUsePct |
| Bond Iss Meet Prvt Sec Pymt Test | 0 | BondIssMeetPrvtSecPymtTestInd |
| Change In Use Bond Financed Prop | 0 | ChangeInUseBondFinancedPropInd |
| Procs Nonqualified Bond Remdtd | 0 | ProcsNonqualifiedBondRemdtdInd |
Tax Exempt Bonds Arbitrage TaxExemptBondsArbitrageGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Form8038 T Filed | 0 | Form8038TFiledInd |
| Rebate Not Due Yet | 0 | RebateNotDueYetInd |
| Exception To Rebate | Yes (1) | ExceptionToRebateInd |
| No Rebate Due | 0 | NoRebateDueInd |
| Variable Rate Issue | 0 | VariableRateIssueInd |
| Hedge Identified In Bks And Rec | 0 | HedgeIdentifiedInBksAndRecInd |
| Gross Proceeds Invested In GIC | 0 | GrossProceedsInvestedInGICInd |
| Gross Proceeds Invested | 0 | GrossProceedsInvestedInd |
| Written Proc To Monitor Reqs | Yes (1) | WrittenProcToMonitorReqsInd |
Procedures Corrective Action ProceduresCorrectiveActionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Procedures Corrective Action | Yes (1) | ProceduresCorrectiveActionInd |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | FORM 990, SCHEDULE K, PART V, LINE 2B | FormAndLineReferenceDesc |
| Explanation | THE ORGANIZATION QUALIFIES FOR AN EXCEPTION FOR REBATE UNDER THE TEMPORARY PERIOD EXCEPTION, SPECIFICALLY SECTION 148(C)(2)(C). | ExplanationTxt |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (6 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PART VI, SECTION A, LINE 6 | MEMBERSHIP IN THE CORPORATION SHALL BE EITHER LIFETIME OR ANNUAL, AND SHALL BE LIMITED TO ADULT INDIVIDUALS AS FOLLOWS: 1) THOSE INDIVIDUALS OR COMPANIES CONTRIBUTING $100 TO THE CORPORATION, OR TO THE DEVELOPMENT FUND OF THE MEDICAL CENTER CORPORATION, SHALL, UPON SPECIFIC REQUEST, BE ENTITLED TO A LIFE MEMBERSHIP. IF AN INDIVIDUAL OR COMPANY MAKES A CONTRIBUTION OF $200 OR MORE, THEY SHALL BE ENTITLED TO DESIGNATE ONE ADDITIONAL IMMEDIATE FAMILY MEMBER OR COMPANY EMPLOYEE (LIMITED TO TWO PER FAMILY OR COMPANY), RESPECTIVELY, FOR LIFETIME MEMBERSHIP EFFECTIVE RETROACTIVELY. 2) THOSE INDIVIDUALS RESIDING IN THE UNITY MEDICAL CENTER SERVICE AREA SHALL BE GRANTED ANNUAL MEMBERSHIP AT NO FEE. THEY SHALL BE GRANTED ANNUAL MEMBERSHIP STATUS BY SHOWING PROOF OF RESIDING IN THE CORPORATION SERVICE AREA. |
| FORM 990, PART VI, SECTION A, LINE 7A | EACH MEMBER OF THE CORPORATION IN GOOD STANDING SHALL BE QUALIFIED TO CAST ONE VOTE ON ANY ISSUE THAT MAY PROPERLY COME BEFORE ANY MEETING OF THE MEMBERS OF THE CORPORATION, AND TO HOLD ANY OFFICE IN THE CORPORATION TO WHICH HE OR SHE MAY BE ELECTED OR APPOINTED. |
| FORM 990, PART VI, SECTION B, LINE 11 | THE CFO & CEO WILL REVIEW A DRAFT OF THE FORM 990. UNITY MEDICAL CENTER WILL PROVIDE THE BOARD MEMBERS WITH A LINK AND A PASSWORD TO AN ELECTRONIC COPY OF THE 990. |
| FORM 990, PART VI, SECTION B, LINE 12C | ANNUALLY BOARD MEMBERS MUST SIGN A CONFLICT OF INTEREST POLICY. IF A BOARD MEMBER BELIEVES THAT A CONFLICT EXISTS IT IS THEIR RESPONSIBILITY TO BRING THE CONFLICT TO THE ATTENTION OF THE BOARD. THE BOARD WILL DETERMINE IF A CONFLICT EXISTS. ANY BOARD MEMBERS WITH A CONFLICT OF INTEREST MUST ABSTAIN FROM VOTING ON ANY ISSUES RELATING TO THE CONFLICT. |
| FORM 990, PART VI, SECTION B, LINE 15 | A FORMAL EVALUATION IS COMPLETED FOR BOTH THE CEO AND CFO. COMPARABILITY DATA IS USED FROM THE NORTH DAKOTA HOSPITAL ASSOCIATION. AT BUDGET TIME EACH YEAR THE BOARD WILL APPROVE A PERCENTAGE INCREASE. THE DELIBERATION AND DECISION IS DOCUMENTED IN THE BOARD MINUTES. THE PROCESS WAS LAST COMPLETED IN JUNE 2015. |
| FORM 990, PART VI, SECTION C, LINE 19 | THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC AND ANNOUNCES SUCH AT BOARD MEETINGS. |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp
Disregarded Entity Name DisregardedEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | UNITY MEDICAL CENTER FOUNDATION | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 164 WEST 13TH STREET | AddressLine1Txt |
| City | GRAFTON | CityNm |
| State Abbreviation | ND | StateAbbreviationCd |
| ZIP | 58237 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 363522304 | EIN |
| Primary Activities | FUNDRAISING FOR UNITY MEDICAL CENTER | PrimaryActivitiesTxt |
| Legal Domicile State | ND | LegalDomicileStateCd |
| Exempt Code Section | 501(C)(3) | ExemptCodeSectionTxt |
| Public Charity Status | LINE 7 | PublicCharityStatusTxt |
Direct Controlling Entity Name DirectControllingEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CHRISTIAN UNITY HOSPITAL CORPORATION DBA UNITY MEDICAL CENTER | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Controlled Organization | Yes (1) | ControlledOrganizationInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | 0 | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | 0 | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | Yes (1) | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | 0 | LoansOrGuaranteesFromOthOrgInd |
| Div Related Organization | 0 | DivRelatedOrganizationInd |
| Asset Sale To Other Org | 0 | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | 0 | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | 0 | AssetExchangeInd |
| Rental Of Facilities To Oth Org | 0 | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | 0 | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | 0 | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | Yes (1) | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | Yes (1) | SharingOfFacilitiesInd |
| Paid Employees Sharing | Yes (1) | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | 0 | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | Yes (1) | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | 0 | TransferToOtherOrgInd |
| Transfer From Other Org | 0 | TransferFromOtherOrgInd |
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