2016-05-16T12:07:49-05:00 2015-06-30 390758449 WIPFLI LLP 7601 FRANCE AVENUE SOUTH SUITE 400 MINNEAPOLIS MN 55435 990 2014-07-01 450310159 CHRISTIAN UNITY HOSPITAL CORPORATION CHRI 7013529365 164 WEST 13TH STREET GRAFTON ND 58257 ALAN O'NEIL CHIEF EXECUTIVE OFFICER 7013529365 2016-05-13 1 TIM A RITTER CPA P00732856 9525483400 2016-05-13 2014 2016-08-17 19:52:53Z UNITY MEDICAL CENTER ALAN O'NEIL 164 WEST 13TH STREET GRAFTON ND 58257 9942974 0 X WWW.UNITYMEDCENTER.COM X 1970 ND PROVIDE ACCESS TO QUALITY HEALTH CARE FOR THE REGION. 9 8 137 30 0 0 445827 561684 8291378 9340742 1274 0 9130 40548 8747609 9942974 0 0 0 0 4888973 5422362 0 0 0 3919015 4188390 8807988 9610752 -60379 332222 5002283 5266243 3068720 3000458 1933563 2265785 X UNITY MEDICAL CENTER PROVIDES ACCESS TO QUALITY HEALTH CARE FOR THE REGION. 0 0 8104447 0 9364262 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 JUNE30, 2015 THE MEDICAL CENTER PROVIDED AS PART OF ITS MISSION 676 ACUTE DAYS, 778 SWING BED DAYS, 51 RESPITE DAYS AND 11,113 CLINIC VISITS. THE AMOUNT OF CHARGES FOREGONE FOR SERVICES PROVIDED UNDER THEORGANIZATION'S CHARITY CARE POLICY WAS APPROXIMATELY $5,000 FOR THE FISCAL YEAR. TOTAL DIRECT AND INDIRECT COSTS RELATED TO THESE FOREGONE CHARGES WAS $3,700, BASED ON AN AVERAGE RATIO OF COSTS TO GROSS CHARGES. 8104447 1 1 0 1 0 0 0 0 0 0 1 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 1 1 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 1 32 0 137 1 0 0 0 0 0 0 0 0 0 0 X 9 8 0 0 0 0 1 1 0 1 1 0 0 1 1 1 1 0 1 1 1 0 X ALAN O'NEIL 7013529365 164 WEST 13TH STREET GRAFTON ND 58257 TOM CAMPBELL BOARD MEMBER 1.50 X 0 0 0 ROGER GORDER BOARD MEMBER 1.50 X 0 0 0 VICKI HAM BOARD MEMBER (THRU SEPTEMBER) 1.00 X 0 0 0 MARY HOUDEK BOARD MEMBER 1.50 X 0 0 0 DR ANTHONY KOTNIK BOARD MEMBER 40.00 X 183432 0 28015 TODD MORGAN BOARD MEMBER 1.50 X 0 0 0 HEIDI PAULSON BOARD MEMBER 1.50 X 0 0 0 KEITH ZIKMUND PRESIDENT (THRU OCTOBER) 1.00 X X 0 0 0 JO PETERSON PRESIDENT 2.00 1.00 X X 0 0 0 PASTOR CHRIS GAULE VICE PRESIDENT 2.00 X X 0 0 0 AMY VOLLRATH SECRETARY/TREASURER 1.50 X X 0 0 0 ALAN O'NEIL CHIEF EXECUTIVE OFFICER 40.00 X 92308 0 1541 RACHEL RAY CHIEF FINANCIAL OFFICER 40.00 X 87948 0 7772 MIRIAM ANDERSON FAMILY NURSE PRACTITIONER 40.00 X 124673 0 13705 DR LINDA FILLIPI PHYSICIAN 40.00 X 177658 0 9599 MARCIA KETTERLING FAMILY NURSE PRACTITIONER 40.00 X 122295 0 8152 DR JOSHUA OMOTUNDE PHYSICIAN 40.00 X 322717 0 33281 DR ELIZABETH SUNDBERG PHYSICIAN 40.00 X 150455 0 8597 1261486 0 110662 6 0 1 0 DMS 26283 NETWORK PLACE CHICAGO IL 60673 MOBILE SERVICES 359118 ALTRU PO BOX 13780 GRAND FORKS ND 58208 EPIC TELEPHARMACY 128792 ST PAUL RADIOLOGY PO BOX 2923 INDIANAPOLIS IN 46206 RADIOLOGY READINGS 127556 SIEMAN'S PO BOX 121102 DALLAS TX 75312 REAGENT TESTING SERVICES 110994 4 146889 382190 32605 561684 NET PATIENT SERVICE RE 621300 9285682 9285682 OTHER MEDICAL SERVICES 621300 55060 55060 9340742 EHR INCENTIVE REVENUE 621300 23520 23520 17028 17028 40548 9942974 9364262 0 17028 456612 373115 83497 4252059 3478141 773918 445892 360299 85593 267799 218866 48933 11513 11513 51582 51582 5967 5967 812009 764903 47106 37413 37413 633522 531792 101730 104336 104336 149964 149964 35975 22464 13511 122552 122552 357195 357195 93957 93957 MEDICAL SUPPLIES 846652 846652 PROVISION FOR BAD DEBT 809154 809154 COMMUNICATIONS 63045 35887 27158 DUES AND SUBSCRIPTIONS 18010 3909 14101 35544 29554 5990 9610752 8104447 1506305 0 472186 770362 1818570 1828094 108042 117184 12722 36325 10384155 8049854 2538926 2334301 51837 179977 5002283 5266243 795566 949776 2085000 2035000 78854 15682 109300 0 3068720 3000458 X 1831868 2206938 101695 58847 1933563 2265785 5002283 5266243 332222 0 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 2377 2377 0 PART II-B, LINE 1: 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. 43017 43017 4845792 3159581 1686211 5495346 4890273 605073 2334301 8992853 42848 42848 8950005 5967 987002 992969 9942974 8795631 0 8795631 5967 809154 815121 9610752 PART XI, LINE 2D - OTHER ADJUSTMENTS: NET ASSETS RELEASED FROM RESTRICTIONS 42,848. PART XI, LINE 4B - OTHER ADJUSTMENTS: PROVISION FOR BAD DEBT 809,154. CONTRIBUTIONS MADE TO NET ASSETS 177,848. PART XII, LINE 4B - OTHER ADJUSTMENTS: PROVISION FOR BAD DEBT 809,154. 1 1 1 X 1 X 1 1 1 0 0 3734 3734 0.00040 911810 836596 75214 0.00850 915544 836596 78948 0.00890 846 846 0.00010 846 846 0.00010 916390 836596 79794 0.00900 0 586969 58110 4110274 4094469 15805 X 1 1 1 1 CHRISTIAN UNITY HOSPITAL CORPORATION 164 WEST 13TH STREET GRAFTON ND 58257 WWW.UNITYMEDICALCENTER.COM 5020 X X X X CHRISTIAN UNITY HOSPITAL CORPORATION 1 0 0 1 X X X X X X X X 12 1 0 0 1 X SEE SUPPLEMENTAL INFORMATION X X 1 12 1 SEE SUPPLEMENTAL INFORMATION 1 0 1 X 100.000000000000 200.000000000000 X 1 1 X X X X X 1 X X X X X 1 X 0 X 1 X 0 0 CHRISTIAN UNITY HOSPITAL CORPORATION PART V, SECTION B, LINE 5: 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. TWO VERSIONS OF A SURVEY TOOL WERE DISTRIBUTED TO TWO DIFFERENT AUDIENCES: (1) COMMUNITY MEMBERS AND (2) HEALTH CARE PROFESSIONALS.THE COMMUNITY MEMBER SURVEY WAS DISTRIBUTED TO VARIOUS RESIDENTS OF THE SERVICE AREA OF UNITY MEDICAL CENTER. THE SURVEY TOOL WAS DESIGNED TO UNDERSTAND COMMUNITY AWARENESS ABOUT SERVICES PROVIDED BY THE LOCAL HEALTH SYSTEM AND WHETHER CONSUMERS ARE USING LOCAL SERVICES; UNDERSTAND THE COMMUNITY'S NEED FOR SERVICES AND CONCERNS ABOUT THE DELIVERY OF HEALTH CARE IN THE COMMUNITY; LEARN ABOUT BROAD AREAS OF COMMUNITY CONCERNS; LEARN OF RESIDENTS' PERCEPTIONS ABOUT COMMUNITY ASSETS; DETERMINE PREFERENCES FOR USING LOCAL HEALTH CARE VERSUS TRAVELING TO OTHER FACILITIES; AND SOLICIT SUGGESTIONS AND HELP IDENTIFY ANY GAPS IN SERVICES (NOW AND IN THE FUTURE). SPECIFICALLY, THE SURVEY COVERED THE FOLLOWING TOPICS: COMMUNITY ASSETS, AWARENESS AND UTILIZATION OF LOCAL HEALTH SERVICES, BARRIERS TO USING LOCAL SERVICES, SUGGESTIONS FOR IMPROVING COLLABORATION WITHIN THE COMMUNITY, LOCAL HEALTH CARE DELIVERY CONCERNS, REASONS CONSUMERS USE LOCAL HEALTH CARE PROVIDERS AND REASONS THEY SEEK CARE ELSEWHERE, TRAVEL TIME TO THE NEAREST CLINIC AND TO THE UNITY MEDICAL CENTER HOSPITAL IN GRAFTON, DEMOGRAPHICS (GENDER, AGE, YEARS IN COMMUNITY, MARITAL STATUS, EMPLOYMENT STATUS, INCOME, AND INSURANCE STATUS), AND RESPONDENTS' CURRENT HEALTH CONDITIONS OR DISEASES. APPROXIMATELY 500 COMMUNITY MEMBER SURVEYS WERE DISTRIBUTED IN THE SERVICE AREA. THE SURVEYS WERE DISTRIBUTED THROUGH MEMBERS OF THE COMMUNITY GROUP AND AT AREA CHURCHES, COMMUNITY EVENTS, UMC FACILITIES, AND SENIOR CENTERS. TO HELP ENSURE CONFIDENTIALITY AND ANONYMITY, INCLUDED WITH EACH SURVEY WAS A POSTAGE-PAID RETURN ENVELOPE TO THE CENTER FOR RURAL HEALTH. THE SURVEY TOOK PLACE IN JUNE AND JULY, 2012. APPROXIMATELY 47 COMPLETED COMMUNITY MEMBER SURVEYS WERE RETURNED. AREA RESIDENTS ALSO WERE GIVEN THE OPTION OF COMPLETING AN ONLINE VERSION OF THE SURVEY, WHICH WAS PUBLICIZED IN THE LOCAL NEWSPAPER. TWENTY-THREE ONLINE SURVEYS WERE COMPLETED, MAKING A TOTAL OF 70 SURVEYS COMPLETED BY COMMUNITY MEMBERS.EMPLOYEES OF UNITY MEDICAL CENTER WERE ENCOURAGED TO COMPLETE AN ONLINE VERSION OF THE SURVEY GEARED TO HEALTH CARE PROFESSIONALS. APPROXIMATELY 59 OF THESE SURVEYS WERE COMPLETED ONLINE. THE VERSION OF THE SURVEY FOR HEALTH CARE PROFESSIONALS COVERED THE SAME TOPICS AS THE CONSUMER SURVEY, ALTHOUGH IT SOUGHT LESS DEMOGRAPHIC INFORMATION AND DIDN'T ASK WHETHER HEALTH CARE PROFESSIONALS WERE AWARE OF THE SERVICES OFFERED BY UNITY MEDICAL CENTER. CHRISTIAN UNITY HOSPITAL CORPORATION PART V, SECTION B, LINE 7D: CHNA AVAILABLE ON THE FOLLOWING WEBSITE URL:HTTP://WWW.UNITYMEDCENTER.COM/FILES/6813/9291/8818/COMMUNITY_HEALTH_NEEDS_ASSESSMENT_FINAL_REPORT.PDFIMPLEMENTATION ON THE FOLLOWING WEBSITE URL:HTTP://WWW.UNITYMEDCENTER.COM/FILES/1414/2922/0402/COMMUNITY-NEEDS-ASSESSMENT-IMPLEMENTATION-STRATEGY.PDF CHRISTIAN UNITY HOSPITAL CORPORATION PART V, SECTION B, LINE 11: ONE OF THE NEEDS IDENTIFIED IN THE CHNA WHICH IS NOT BEING ADDRESSED IS KIDNEY DIALYSIS. KIDNEY DIALYSIS REQUIRES A SUBSTANTIAL FINANCIAL OUTLAY AND THE NUMBER OF DIALYSIS PATIENTS IN OUR STUDY DOES NOT SUPPORT A DIALYSIS UNIT, BUT, POTENTIALLY, WE COULD HAVE A VISITING PHYSICIAN ADDRESS THIS ISSUE. WE HAVE NOT BEEN ABLE TO FIND A VISITING PHYSICIAN TO ADDRESS THIS ISSUE. ON THE PRIOR YEAR SCHEDULE H, DERMATOLOGY WAS A NEED THAT HAD NOT BEEN ADDRESSED. SINCE THAT REPORTING PERIOD, THE ORGANIZATION OFFERS DERMATOLOGY SERVICES 3 TIMES A MONTH. ALSO IN THE PRIOR YEAR, THE ORGANIZATION BEGAN TO ADDRESS THE NEED FOR INCREASED COLORECTAL CANCER SCREENINGS. DUE TO TURNOVER, THE ORGANIZATION HAS NOT BEEN ABLE TO FIND A REPLACEMENT TO CONTINUE THIS EFFORT IN THE CURRENT YEAR. IT IS STILL A NEED THE ORGANIZATION IS EXPECTING TO ADDRESS. 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. 1 GRAFTON FAMILY CLINIC 155 WEST 14TH STREET GRAFTON ND 58257 RURAL HEALTH CLINIC 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 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 $ 809,154. 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 INCREASED FROM 54% OF SELF-PAY ACCOUNTS RECEIVABLE AT JUNE 30, 2014, TO 70% SELF-PAY ACCOUNTS RECEIVABLE AT JUNE 30, 2015. 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 2015 OR 2014. 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 DETERMING 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. 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 TRY TO MAKE ARRANGEMENTS OVER THE PHONE AND THROUGH THE MAIL, IF NECESSARY. 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 $44,139 FOR 2006-2010 PER THE US CENSUS DATA. 9.9% OF INDIVIDUALS IN THE WALSH COUNTY FALL BELOW THE POVERTY LEVEL. UNITY MEDICAL CENTER SERVES THE POPULATION OF GRAFTON AND SEVERAL SURROUNDINGSMALLER COMMUNITIES. THE AREA IS ALSO SERVED BY A HOSPITAL IN PARK RIVER AND A HOSPITAL IN GRAND FORKS. APPROXIMATELY 7.5% OF THE HOSPITAL'S BUSINESS IN FY 2014 WAS TO PRIVATE PAY INDIVIDUALS. APPROXIMATELY 8.6% OF OUR BUSINESS WAS TO MEDICAID RECIPIENTS. WE ALSO HAVE A MIGRANT HEALTH OFFICE IN THE COMMUNITY TO SERVE MIGRANT WORKERS. 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. 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, KIDS UMC (EDUCATION FOR YOUNG CHILDREN), ETC. UMC ALSO HAS A REPRESENTATIVE ON THE MAYOR'S COMMITTEE OF WELLNESS FOR THE COMMUNITY. UMC BRINGS IN SPECIALTY DOCTORS TO OUR CLINIC IN ORDER TO OFFER MORE NECESSARY SERVICES TO OUR PATIENT POPULATION, I.E. ONCOLOGY, PSYCHIATRY, 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 X X 0 0 0 1 0 0 0 0 0 DR ANTHONY KOTNIK BOARD MEMBER 140192 0 43240 0 0 0 0 0 28015 0 211447 0 0 0 DR LINDA FILLIPI PHYSICIAN 139628 0 38030 0 0 0 0 0 9599 0 187257 0 0 0 DR JOSHUA OMOTUNDE PHYSICIAN 137563 0 185154 0 0 0 0 0 33281 0 355998 0 0 0 DR ELIZABETH SUNDBERG PHYSICIAN 140455 0 0 0 10000 0 0 0 8597 0 159052 0 0 0 PART I, LINE 5 PHYSICIAN COMPENSATION IS CALCULATED MONTHLY. PHYSICIANS EARN 58 PERCENT OF GROSS REVENUES FROM GROSS PROFESSIONAL CHARGES. A CITY OF GRAFTON 456002080 384455BF7 2008-04-23 2363560 CAPITAL IMPROVEMENTS TO THE HOSPITAL 0 0 0 A 328560 2363560 47000 2316560 2009 0 0 1 1 A 0 0 0 0 0.00000 0.00000 0.00000 0 0 0 A 0 0 1 0 0 0 0 0 0 A 0 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. UNITY MEDICAL CENTER FOUNDATION 164 WEST 13TH STREET GRAFTON ND 58237 363522304 FUNDRAISING FOR UNITY MEDICAL CENTER ND 501(C)(3) LINE 7 CHRISTIAN UNITY HOSPITAL CORPORATION DBA UNITY MEDICAL CENTER 1 0 1 0 0 0 0 0 0 0 0 0 0 0 1 1 0 1 0 0 UNITY MEDICAL CENTER FOUNDATION C 146889 CASH